Clinical Characteristics and Postoperative Outcomes of Primary Aldosteronism in the Elderly

Takeda, Masao; Yamamoto, Kōichi; Akasaka, Hiroshi; Rakugi, Hiromi; Naruse, Mitsuhide; Takeda, Yoshiyu; Kurihara, Isao; Itoh, Hiroshi; Umakoshi, Hironobu; Tsuiki, Mika; Ichijo, Takamasa; Katabami, Takuyuki; Wada, Norio; Shibayama, Yuki; Yoshimoto, Takanobu; Ogawa, Yoshihiro; Kawashima, Junji; Sone, Masakatsu; Inagaki, Nobuya; Takahashi, K.; Fujita, Megumi; Watanabe, Minemori; Matsuda, Yuichi; Kobayashi, Hiroki; Shibata, Hirotaka; Kamemura, Kohei; Otsuki, Michio; Fujii, Yukihiko; Ogo, Atsushi; Okamura, Shintaro; Miyauchi, Shozo; Yanase, Toshihiko; Suzuki, Tomoko; Kawamura, Takashi

doi:10.1210/jc.2018-00059

Cited by 34 publications

(40 citation statements)

References 33 publications

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“…Since age is an independent factor responsible for the postsurgical outcome as described above, high prevalence of APA in younger patients in female and older patients in male could be responsible for the gender difference in surgical outcome. In agreement with this, the gender was no longer a determinant of complete clinical success after ADX in the elderly patients [6].…”

Section: Gendersupporting

confidence: 62%

“…Details of the surgical outcome in the elderly, however, remains to be elucidated. Clinical characteristics of PA patients in the elderly and clinical outcome after ADX were investigated in the JPAS/JRAS database [6]. In total, among the 1902 patients with successful adrenal venous sampling (AVS), 326 patients were aged 65 years or older, and the median age of these elderly patients was 68 years old [6].…”

Section: Agementioning

confidence: 99%

“…Clinical characteristics of PA patients in the elderly and clinical outcome after ADX were investigated in the JPAS/JRAS database [6]. In total, among the 1902 patients with successful adrenal venous sampling (AVS), 326 patients were aged 65 years or older, and the median age of these elderly patients was 68 years old [6]. The elderly PA patients had lower renal function and higher prevalence of comorbidities than the non-elderly patients.…”

Section: Agementioning

confidence: 99%

“…Unfavorable outcomes such as hyperkalemia and renal insufficiency should also be considered after ADX in the elderly [6]. The prevalence of hyperkalemia (15 vs. 5 %, p = 0.002) and renal impairment (CKD ≥ stage 3b) (27 vs. 12 %, p < 0.001) after adrenalectomy was significantly higher in the elderly patients than the non-elderly patients.…”

Section: Agementioning

confidence: 99%

“…However, rate of clinical cure in terms of hypertension resolution after ADX has been reported to be significantly lower than the biochemical cure rate [4,5]. Various factors have been described to account for the difference between the clinical and biochemical cure rate after ADX [6][7][8].…”

Section: Introductionmentioning

confidence: 99%

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Age, Gender, and Body Mass Index as Determinants of Surgical Outcome in Primary Aldosteronism

et al. 2020

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Although unilateral primary aldosteronism (PA) should be curable by adrenalectomy (ADX), postsurgical outcome is affected by several clinical factors. Herein we reviewe the importance of age, gender, and BMI as determinants of surgical success based on the recent findings including a nation-wide, multicenter study in Japan (JPAS/JRAS). It is important to determine whether ADX for elderly patients with unilateral PA is as beneficial as younger patients. JPAS/JRAS showed that ADX could benefit elderly patients (>65 years) with definitive unilateral PA in curing of disease and improvement of hypertension, although potential adverse outcomes including hyperkalemia and renal insufficiency need to be considered in some elderly patients at high risk. As shown in previous studies, JPAS/JRAS also demonstrated that female gender was an independent predictor for clinical cure after ADX in patients with unilateral PA. The gender-specific predominance of somatic mutations of aldosterone-producing adenoma and sex hormones with vasculo-protective effects might account for the difference of surgical outcome between genders. Additionally, lower body mass index (BMI) has been shown to be one of the predictive factors for better clinical outcome after ADX. The relation between BMI and surgical outcome is, however, independent from aldosterone, since BMI does not correlate with PAC in PA. Early diagnosis of PA and lifestyle modification including weight control are essential to improve the surgical outcome of the unilateral PA. Thus, clinical practice guideline should include sophisticated strategy of ADX considering not only subtype diagnosis by adrenal venous sampling but also age, gender, and BMI to predict better surgical outcome.

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Section: Gendersupporting

confidence: 62%

Section: Agementioning

confidence: 99%

Section: Agementioning

confidence: 99%

Section: Agementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Age, Gender, and Body Mass Index as Determinants of Surgical Outcome in Primary Aldosteronism

et al. 2020

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Use of Steroid Profiling Combined With Machine Learning for Identification and Subtype Classification in Primary Aldosteronism

et al. 2020

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IMPORTANCE Most patients with primary aldosteronism, a major cause of secondary hypertension, are not identified or appropriately treated because of difficulties in diagnosis and subtype classification. Applications of artificial intelligence combined with mass spectrometry-based steroid profiling could address this problem. OBJECTIVE To assess whether plasma steroid profiling combined with machine learning might facilitate diagnosis and treatment stratification of primary aldosteronism, particularly for patients with unilateral adenomas due to pathogenic KCNJ5 sequence variants. DESIGN, SETTING, AND PARTICIPANTS This diagnostic study was conducted at multiple tertiary care referral centers. Steroid profiles were measured from June 2013 to March 2017 in 462 patients tested for primary aldosteronism and 201 patients with hypertension. Data analyses were performed from September 2018 to August 2019. MAIN OUTCOMES AND MEASURES The aldosterone to renin ratio and saline infusion tests were used to diagnose primary aldosteronism. Subtyping was done by adrenal venous sampling and follow-up of patients who underwent adrenalectomy. Statistical tests and machine-learning algorithms were applied to plasma steroid profiles. Areas under receiver operating characteristic curves, sensitivity, specificity, and other diagnostic performance measures were calculated. RESULTS Primary aldosteronism was confirmed in 273 patients (165 men [60%]; mean [SD] age, 51 [10] years), including 134 with bilateral disease and 139 with unilateral adenomas (58 with and 81 without somatic KCNJ5 sequence variants). Plasma steroid profiles varied according to disease subtype and were particularly distinctive in patients with adenomas due to KCNJ5 variants, who showed better rates of biochemical cure after adrenalectomy than other patients. Among patients tested for primary aldosteronism, a selection of 8 steroids in combination with the aldosterone to renin ratio showed improved effectiveness for diagnosis over either strategy alone. In contrast, the steroid profile alone showed superior performance over the aldosterone to renin ratio for identifying unilateral disease, particularly adenomas due to KCNJ5 variants. Among 632 patients included in the analysis, machine learning-designed combinatorial marker profiles of 7 steroids alone both predicted primary aldosteronism in 1 step and subtyped patients with unilateral adenomas due to KCNJ5 variants at diagnostic sensitivities of 69% (95% CI, 68%-71%) and 85% (95% CI, 81%-88%), respectively, and at specificities of 94% (95% CI, 93%-94%) and 97% (95% CI, 97%-98%), respectively. The validation series yielded comparable diagnostic performance. CONCLUSIONS AND RELEVANCE Machine learning-designed combinatorial plasma steroid profiles may facilitate both screening for primary aldosteronism and identification of patients with unilateral (continued) Key Points Question Does steroid profiling combined with machine learning offer a potential 1-step strategy to facilitate diagnosis and subtype classification for t...

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Impact of Primary Aldosteronism in Resistant Hypertension

et al. 2022

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Clinical Characteristics and Postoperative Outcomes of Primary Aldosteronism in the Elderly

Cited by 34 publications

References 33 publications

Age, Gender, and Body Mass Index as Determinants of Surgical Outcome in Primary Aldosteronism

Age, Gender, and Body Mass Index as Determinants of Surgical Outcome in Primary Aldosteronism

Use of Steroid Profiling Combined With Machine Learning for Identification and Subtype Classification in Primary Aldosteronism

Impact of Primary Aldosteronism in Resistant Hypertension

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