In primary hyperaldosteronism due to Conn's syndrome, the definitive surgical treatment is?

• A. Spironolactone therapy
• B. Excision of adrenal aldosteronoma
• C. Renovascular with angioplasty
• D. Adrenal venous sampling

Answer: (B)

Unilateral aldosterone excess from an aldosterone-producing adenoma (Conn's syndrome) is cured best by removing the adrenal gland that contains the tumor. This definitive excision eliminates the source of excess aldosterone, which normalizes sodium handling, blood pressure, and potassium levels. Spironolactone or other mineralocorticoid receptor antagonists can control symptoms but do not eradicate the tumor. Adrenal venous sampling is a diagnostic test used to determine whether aldosterone overproduction is unilateral or bilateral and thus guides surgical decision-making, while angioplasty targets renovascular hypertension, not an aldosterone-producing tumor. Preoperative optimization treats potassium and BP and after surgery, monitoring for potential adrenal insufficiency is important.