In a patient with primary hyperaldosteronism (PA), which subtype classification requires unilateral adrenalectomy rather than medical management with mineralocorticoid receptor antagonists?

• A Bilateral adrenal hyperplasia (idiopathic hyperaldosteronism)
• B Unilateral adrenal adenoma (Conn's syndrome) ✓
• C Glucocorticoid-remediable aldosteronism (familial PA type 1)
• D Adrenal carcinoma with glucocorticoid co-secretion

Explanation

Unilateral adrenal adenoma causing PA (Conn's syndrome) is the primary surgical indication — adrenalectomy normalises aldosterone and hypertension in >90% of cases. Bilateral adrenal hyperplasia is best managed medically with spironolactone or eplerenone. Glucocorticoid-remediable aldosteronism responds to exogenous glucocorticoids. Adrenal carcinoma requires surgery but is not managed for PA per se.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

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