Skip to content
How It Works
Explore
Ask a Question Resources Pricing
Who It's For
Patients
Decode results, prep for appointments, weigh options.
Caregivers & advocates
Carry the research load for someone you love.
Providers & clinicians
Resources for patients in your practice.
Log In Ask a Question
PubMed This is a summary of 16 peer-reviewed journal articles Updated
Endocrinology · Primary Aldosteronism

Surgical Treatment: The Path to a Cure

At a Glance

Unilateral adrenalectomy is the most effective treatment for one-sided primary aldosteronism. Nearly 95% of patients achieve normal hormone levels after surgery, and up to 54% can stop all blood pressure medications. Importantly, it provides excellent long-term protection for your heart.

If testing has confirmed that your excess aldosterone is coming from only one of your adrenal glands, your medical team will likely recommend a unilateral adrenalectomy. This is a surgical procedure to remove the overactive gland, and it is considered the gold standard of care for one-sided Primary Aldosteronism (PA) [1][2].

The primary benefit of surgery over medication is that it addresses the root cause of the disease. While medications can block the effects of aldosterone, surgery removes the source of the “hormonal toxin” entirely, providing superior long-term protection for your heart and brain [3][4].

Measuring Success: The PASO Criteria

To help patients and doctors understand what to expect after surgery, experts developed the PASO (Primary Aldosteronism Surgical Outcome) criteria [5]. Success is measured in two different ways:

  1. Biochemical Success (Hormone Balance): This is the “cure” of the underlying disease. It is achieved when your potassium levels return to normal without supplements and your aldosterone-to-renin ratio (ARR) is no longer elevated [6]. Nearly 95% of patients achieve a complete biochemical cure [7].
  2. Clinical Success (Blood Pressure): This measures how your blood pressure responds [5].
    • Complete Success: Your blood pressure returns to normal (<140/90 mmHg) and you no longer need any blood pressure medications [8]. This occurs in roughly 30% to 54% of patients [7][9].
    • Partial Success: Your blood pressure is easier to control, meaning you take fewer medications than before, or your blood pressure is significantly lower on the same amount of medication [10].
    • Absent Success: Your blood pressure remains the same despite the hormone levels being fixed.

Why Doesn’t Everyone Get a “Complete” Clinical Cure?

It is important to understand that even if the surgery is 100% successful at fixing your hormones, your blood pressure might not return to “perfect” without medication. This is usually because years of high blood pressure can cause permanent changes to your blood vessels and kidneys [8].

You are more likely to achieve a complete clinical cure if you [11][8][12]:

  • Have had high blood pressure for a shorter amount of time (typically less than 5–10 years).
  • Are younger.
  • Are female.
  • Have a lower Body Mass Index (BMI).
  • Were taking fewer blood pressure medications before the surgery.

What to Expect After Surgery

Most adrenalectomies are performed using laparoscopic (minimally invasive) techniques, which typically allow for a faster recovery [13].

  • Potassium and Medication Changes: You will likely be able to stop taking potassium supplements immediately. Your doctor will also begin reducing your blood pressure medications, often starting the very day after surgery [7].
  • Kidney Function: You may notice a slight drop in your kidney function numbers (eGFR) in the weeks following surgery [14]. This is usually not a sign of damage; instead, it is your kidneys “resetting” after being forced to over-filter blood by the excess aldosterone [15].
  • Long-Term Protection: Even if you fall into the “partial success” category and still need one or two blood pressure pills, the surgery has still removed the toxic levels of aldosterone. This significantly lowers your lifetime risk of having a stroke, heart attack, or developing atrial fibrillation compared to managing the disease with medication alone [3][16].

Common questions in this guide

What is the success rate of surgery for primary aldosteronism?
Nearly 95% of patients achieve a complete biochemical cure, meaning their hormone levels return to normal. However, only 30% to 54% of patients will be able to completely stop taking blood pressure medications after surgery.
Why might I still need blood pressure medication after an adrenalectomy?
Even if surgery successfully fixes your hormones, years of high blood pressure can cause permanent changes to your blood vessels and kidneys. Many patients will still have significantly lower blood pressure or require fewer medications, even if they aren't completely cured of hypertension.
What happens to my kidney function after adrenal gland removal?
You may notice a slight drop in your kidney function numbers (eGFR) in the weeks following surgery. This is typically a normal reset of your kidneys after being forced to over-filter blood by the excess aldosterone, rather than a sign of permanent damage.
Am I a candidate for a minimally invasive adrenalectomy?
Most adrenalectomies for primary aldosteronism are performed using laparoscopic techniques. Your surgical team will evaluate your specific medical history and anatomy to determine if this minimally invasive approach is right for you.

Questions to Ask Your Doctor

Curated prompts to bring to your next appointment.

  1. 1.Am I a candidate for a laparoscopic (minimally invasive) adrenalectomy?
  2. 2.Based on my age and how long I've had high blood pressure, what is the likelihood that I will be able to stop all blood pressure medications after surgery?
  3. 3.Will we test the removed adrenal gland for specific genetic mutations, like KCNJ5, to help understand my long-term outlook?
  4. 4.How soon after the surgery will we re-check my aldosterone, renin, and potassium levels to confirm a 'biochemical cure'?
  5. 5.Should I expect a temporary change in my kidney function (eGFR) after the procedure, and how will we monitor that?

Questions For You

Tap a prompt to share your answer — we'll use it plus this page's context to start a tailored conversation.

References

References (16)
  1. 1

    Re-evaluating absent clinical success after adrenalectomy in unilateral primary aldosteronism.

    Chan YHB, Loh LM, Foo RS, et al.

    Surgery 2021; (170(5)):1389-1396 doi:10.1016/j.surg.2021.05.038.

    PMID: 34183182
  2. 2

    Japan Endocrine Society clinical practice guideline for the diagnosis and management of primary aldosteronism 2021.

    Naruse M, Katabami T, Shibata H, et al.

    Endocrine journal 2022; (69(4)):327-359 doi:10.1507/endocrj.EJ21-0508.

    PMID: 35418526
  3. 3

    Major Adverse Cardiovascular Events in Primary Aldosteronism After Adrenalectomy or Mineralocorticoid Receptor Antagonist Treatment: A Systematic Review and Meta-Analysis.

    Huang CW, Huang TY, Yang YF, et al.

    Journal of the American Heart Association 2025; (14(3)):e038714 doi:10.1161/JAHA.124.038714.

    PMID: 39895534
  4. 4

    Stroke Risks in Primary Aldosteronism with Different Treatments: A Systematic Review and Meta-Analysis.

    Qian N, Xu J, Wang Y

    Journal of cardiovascular development and disease 2022; (9(9)) doi:10.3390/jcdd9090300.

    PMID: 36135445
  5. 5

    Outcomes after adrenalectomy for unilateral primary aldosteronism: an international consensus on outcome measures and analysis of remission rates in an international cohort.

    Williams TA, Lenders JWM, Mulatero P, et al.

    The lancet. Diabetes & endocrinology 2017; (5(9)):689-699 doi:10.1016/S2213-8587(17)30135-3.

    PMID: 28576687
  6. 6

    Clinical outcomes after surgery for primary aldosteronism: Evaluation of the PASO-investigators' consensus criteria within a worldwide cohort of patients.

    Vorselaars WMCM, van Beek DJ, Postma EL, et al.

    Surgery 2019; (166(1)):61-68 doi:10.1016/j.surg.2019.01.031.

    PMID: 31053245
  7. 7

    Biochemical and clinical remission after adrenalectomy in patients with primary aldosteronism: a retrospective two-center study.

    Matthey Giè ML, St-Amour P, Karenovics W, et al.

    Gland surgery 2026; (15(5)):137 doi:10.21037/gs-2026-1-0087.

    PMID: 42299293
  8. 8

    Long-term outcome success after operative treatment for primary aldosteronism.

    Picado O, Whitfield BW, Khan ZF, et al.

    Surgery 2021; (169(3)):528-532 doi:10.1016/j.surg.2020.07.046.

    PMID: 32948336
  9. 9

    ASO Author Reflections: Predicting Postoperative Resolution of Hypertension in Primary Hyperaldosteronism.

    Chatani PD, Dominguez DA, Nilubol N

    Annals of surgical oncology 2021; (28(12)):7496 doi:10.1245/s10434-021-09762-w.

    PMID: 33721134
  10. 10

    The Adrenal Vein Sampling Outcomes Study (AVOS): success rates following adrenalectomy for unilateral primary aldosteronism.

    Sawyer N, Glendenning P, Vasikaran SD, et al.

    Pathology 2023; (55(4)):531-537 doi:10.1016/j.pathol.2023.02.002.

    PMID: 37062662
  11. 11

    Factors Associated with Resolution of Hypertension after Adrenalectomy in Patients with Primary Aldosteronism.

    Loh WJ, Lim DST, Loh LM, Kek PC

    Endocrinology and metabolism (Seoul, Korea) 2018; (33(3)):355-363 doi:10.3803/EnM.2018.33.3.355.

    PMID: 30112867
  12. 12

    Clinical and biochemical outcomes after adrenalectomy for primary aldosteronism in tertiary and quaternary referral centers: data from SOPRANO study.

    Marzano L, Ronco C

    Hypertension research : official journal of the Japanese Society of Hypertension 2024; (47(3)):721-734 doi:10.1038/s41440-023-01554-x.

    PMID: 38182902
  13. 13

    Update: Selective adrenal venous sampling (AVS) - Indication, technique, and significance.

    Loberg C, Antoch G, Stegbauer J, et al.

    RoFo : Fortschritte auf dem Gebiete der Rontgenstrahlen und der Nuklearmedizin 2021; (193(6)):658-666 doi:10.1055/a-1299-1878.

    PMID: 33327032
  14. 14

    Renal function after adrenalectomy in patients with primary aldosteronism.

    Stahl KA, Ramonell KM, Puli A, et al.

    Surgery 2026; (189()):109761 doi:10.1016/j.surg.2025.109761.

    PMID: 41046237
  15. 15

    Markers of Kidney Tubular Function Deteriorate While Those of Kidney Tubule Health Improve in Primary Aldosteronism After Targeted Treatments.

    Wu VC, Chan CK, Chueh JS, et al.

    Journal of the American Heart Association 2023; (12(4)):e028146 doi:10.1161/JAHA.122.028146.

    PMID: 36789834
  16. 16

    Aldosterone as a Mediator of Cardiovascular Damage.

    Buffolo F, Tetti M, Mulatero P, Monticone S

    Hypertension (Dallas, Tex. : 1979) 2022; (79(9)):1899-1911 doi:10.1161/HYPERTENSIONAHA.122.17964.

    PMID: 35766038

This page provides educational information about surgical outcomes for primary aldosteronism. Always consult your endocrinologist or endocrine surgeon regarding your specific treatment options and expected outcomes.

Get notified when new evidence is published on hyperaldosteronism.

We monitor PubMed for new peer-reviewed studies on this topic and email a short summary when something meaningful changes.