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Clinical and biochemical outcomes after adrenalectomy and medical treatment in patients with unilateral primary aldosteronism.

Division of Metabolism and Endocrinology, Department of Internal Medicine, St. Marianna University School of Medicine Yokohama City Seibu Hospital, Yokohama. Division of Metabolism and Endocrinology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki. Department of Internal Medicine, Graduate School of Medical Science, Kanazawa University, Kanazawa. Department of Endocrinology, Metabolism and Nephrology, School of Medicine Keio University, Tokyo. Department of Endocrinology and Metabolism, National Hospital Organization Kyoto Medical Center, Kyoto. Department of Endocrinology and Metabolism, Saiseikai Yokohamashi Tobu Hospital, Yokohama. Department of Diabetes and Endocrinology, Sapporo City General Hospital, Sapporo. Department of Molecular Endocrinology and Metabolism, Tokyo Medical and Dental University, Tokyo. Department of Medicine and Bioregulatory Science, Graduate School of Medical Science, Kyushu University, Fukuoka. Department of Metabolic Medicine, Faculty of Life Science, Kumamoto University, Kumamoto. Department of Diabetes, Endocrinology and Nutrition, Kyoto University, Kyoto. Division of Metabolism, Showa General Hospital. Division of Nephrology and Endocrinology, The University of Tokyo, Tokyo. Department of Endocrinology and Diabetes, Okazaki City Hospital, Okazaki. Department of Cardiology, Sanda City Hospital, Sanda. Division of Nephrology, Hypertension and Endocrinology, Nihon University School of Medicine, Tokyo. Department of Endocrinology, Metabolism, Rheumatology and Nephrology, Faculty of Medicine, Oita University, Yufu. Department of Cardiology, Akashi Medical Center, Akashi. Department of Metabolic Medicine, Osaka University Graduate School of Medicine, Osaka. Department of Cardiology, JR Hiroshima Hospital, Hiroshima. Department of Geriatric and General Medicine, Osaka University Graduate School of Medicine, Osaka. Clinical Research Institute, National Hospital Organization Kyusyu Medical Center. Department of Endocrinology and Diabetes Mellitus, Faculty of Medicine, Fukuoka University, Fukuoka. Department of Public Health, School of Medicine, International University of Health and Welfare, Narita. Clinical Research Institute of Endocrinology and Metabolism, Kyoto Medical Center, National Hospital Organization, Kyoto, Japan.

Journal of hypertension. 2019;(7):1513-1520
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Abstract

OBJECTIVES Current clinical guidelines of primary aldosteronism recommend adrenalectomy (AdX) for unilateral primary aldosteronism based on the studies showing the potential superiority of AdX over the medical treatment. However, since most medically treated cases consisted of bilateral primary aldosteronism and all surgically treated cases consisted of unilateral primary aldosteronism, the different subtype of primary aldosteronism could be a bias for their effects. This study compared the effects of AdX and medical therapy in patients with unilateral primary aldosteronism confirmed by adrenal vein sampling. METHODS Of the 339 patients with unilateral primary aldosteronism in the Japan Primary Pldosteronism Study data base, unilateral AdX and treatment with mineral corticoid receptor antagonists (MRAs) was done in 276 patients (AdX group) and in 63 patients (MRAs group), respectively. The effects were compared by the clinical (improvement of blood pressure) and biochemical outcomes (improvement of hypokalemia). RESULTS At baseline, use of potassium replacement, plasma aldosterone concentration, aldosterone-to-renin ratio, estimated glomerular filtration rate, and prevalence of adrenal mass on imaging were higher in the AdX group than in the MRAs group. At 6 months after commencement of specific treatment for primary aldosteronism, clinical outcome and biochemical outcome in the AdX group were superior than those in the MRAs group. The difference of the outcome between the two groups were the case even after adjusting for the different clinical backgrounds in the two groups before the specific treatment. CONCLUSION Our study provides evidence that AdX is the first choice of treatment in the patients with unilateral primary aldosteronism in terms of clinical and biochemical outcome.

Methodological quality

Publication Type : Multicenter Study ; Observational Study

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