Clinical Risk Factors Predicting Postoperative Hyperkalemia in Patients with Unilateral Aldosterone Excess after Adrenalectomy

Program: Abstracts - Orals, Featured Poster Presentations, and Posters
Session: SAT 53-73-Primary Aldosteronism & Mineralocorticoid Excess
Clinical
Saturday, June 15, 2013: 1:45 PM-3:45 PM
Expo Halls ABC (Moscone Center)

Poster Board SAT-65
Eu Jeong Ku*1, Kyeong Seon Park1, Jung Hee Kim2, Ah Reum Kang1, Sang Wan Kim2 and Seong Yeon Kim2
1Seoul National University College of Medicine, 2Seoul National University College of Medicine, Seoul, South Korea
Unilateral aldosterone excess may suppress zona glomerulosa function in contralateral adrenal gland. Adrenalectomy is the first recommended treatment for unilateral aldosterone excess. There have been a few reports regarding hyperkalemia after adrenalectomy due to suppressed contralateral zona glomerulosa insufficiency. The aim of the present study was to analyze the clinical risk factors associated with postoperative hyperkalemia in patients with unilateral aldosterone excess after adrenalectomy.

The study was conducted retrospectively by medical records review in Seoul National University hospital from 2000 and 2012. Eighty-eight patients who underwent adrenalectomy were included. Hyperkalemia was defined as serum potassium greater than 5.0 mmol/L. Clinical risk factors included blood pressure, plasma renin activity (PRA), plasma aldosterone concentration (PAC), serum potassium, serum creatinine, glomerular filtration rate (GFR), number of antihypertensive mediations and use of mineralocorticoid antagonist.

Fourteen of 88 patients (18%) developed postoperative hyperkalemia. In 7 of patients, hyperkalemia was documented only once and return to normal range spontaneously. Prolonged postoperative hyperkalemia more than 3 months was observed in seven patients. Postoperative hyperkalemic patients did not show significant difference in PRA and PAC compared with normokalemic patients. The patient with persistent hyperkalemia were significantly older at diagnosis (59.4 ± 7.3 vs. 45.1 ± 11.1 yr, P = 0.006) and had elevated creatinine (1.51 ± 0.89 vs. 0.93 ± 0.21 mg/dl, P < 0.001) and lower GFR (53.5 ± 10.9 ml/min vs. 81.3 ± 20.1 ml/min, P < 0.001) than normokalemic patients. The incidence of postoperative hyperkalemia was not different between a mineralocorticoid antagonist users (n= 74) and non-users (n = 14).

Persistent postoperative hyperkalemia occurs in 7.9% of adrenalectomized patients with unilateral aldosterone excess. Older age and preoperative renal function were associated with postoperative hyperkalemia. Use of mineralocorticoid antagonists did not prevent postoperative hyperkalemia in our study.

Nothing to Disclose: EJK, KSP, JHK, ARK, SWK, SYK

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