What are the short and long term challenges after surgery for hyperaldosteronism?
Strict attention to eukalemia is important, particularly in the first few days after the operation. Most patients receive normal saline, without potassium, during the immediate postoperative period. A day after the procedure, a plasma aldosterone level is measured, potassium supplements and aldosterone antagonists are discontinued, and the patient is counseled to consume more dietary sodium than usual, to minimize the risk of hyperkalemia while the contralateral adrenal gland recovers function. Hyperkalemia is more common in patients with chronic kidney disease (albuminuria, increased serum creatinine, or both). Long-term resolution of hypokalemia is common, but about 50% of patients remain hypertensive (and require antihypertensive medications), even after a successful operation. Persistent hypertension is more common in older patients and those with a longer duration of hypertension before the diagnosis was made.