Long term success of adrenalectomy for functional tumors
Patients with an APA can expect a ≈ 100% cure of hypokalemia, and > 90% will show significant improvement in hypertension after adrenalectomy. Approximately 30% to 60% can completely stop antihypertensive therapy. Factors that predict a favorable outcome include young age (< 40 years), shorter duration of hypertension (< 6 years), ≤ 2 antihypertensive agents, a good response to spironolactone, female gender, and less severe hypertension. In older patients with severe, longstanding hypertension associated with renal dysfunction, adrenalectomy may not normalize blood pressure but often results in easier control of hypertension with fewer or lower dose medications.
Adrenalectomy for nonfamilial pheochromocytomas is curative in most cases. However, a long-term recurrence rate as high as 25% (metastases indicating that the primary tumor was malignant) has been reported; thus, patients should undergo annual laboratory surveillance for the rest of their lives.
Adrenalectomy in patients with cortisol-producing adrenal adenomas results in excellent improvement in the symptoms of Cushing’s syndrome and improves patient quality of life. Hypertension and diabetes resolve in 65% to 80% of patients, and the physical changes of Cushing’s syndrome are reversed in 85%. These improvements take 6 to 12 months to occur.