Hypertension resolution after adrenalectomy for primary hyperaldosteronism: Which is the best predictive model?

Thiesmeyer, Jessica W.; Ullmann, Timothy M.; Greenberg, June; Williams, Nicholas; Limberg, Jessica; Stefanova, Dessislava; Beninato, Toni; Finnerty, Brendan M.; Vignaud, Timothée; Leclerc, Julie; Fahey, Thomas J.; Mirallié, Éric; Brunaud, Laurent; Zarnegar, Rasa

doi:10.1016/j.surg.2020.04.017

Cited by 10 publications

(11 citation statements)

References 25 publications

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“…Other authors have developed predictive models based on machine learning-procedures, reporting AUC of 0.867 (95% CI 0.763–0.971) based on the combination of duration of hypertension, defined daily dose (DDD) of antihypertensive medication, plasma aldosterone concentration (PAC), sex, BMI, and age [25]. One previous study [26] has also compared the diagnostic accuracy of Wachtel's, Utsumi's and Zarnegar's models, describing that Utsumi's was the model that demonstrated the highest predictive validity in two different cohorts (American and French). Our study is the first to test the diagnostic accuracy of these models in a Spanish population, showing that the accuracy was higher than that observed in the French and American population.…”

Section: Discussionmentioning

confidence: 99%

Predictive model of hypertension resolution after adrenalectomy in primary aldosteronism: the SPAIN-ALDO score

Araujo-Castro

Fano

Boillos

et al. 2022

Journal of Hypertension

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Purpose: To develop a predictive model of hypertension resolution after adrenalectomy in patients with primary aldosteronism (PA), based on their presurgical characteristics.Methods: A retrospective multicenter study of PA patients in follow-up in 20 Spanish tertiary hospitals between 2018 and 2021 was performed (SPAIN-ALDO Register). Clinical response postadrenalectomy was classified according to the primary aldosteronism surgical outcome (PASO) consensus criteria. The predictive model was developed using a multivariate logistic regression model with the estimation of all possible equations.Results: A total of 146 patients (54.8% females; mean age of 51.5 AE 10.9 years) with PA who underwent unilateral adrenalectomy were included. After a mean follow-up of 29.1 AE 30.43 months after surgery, hypertension cure was obtained in 37.7% (n ¼ 55) of the patients. The predictive model with the highest diagnostic accuracy to predict hypertension cure combined the variables female sex, use of two or fewer antihypertensive medications, hypertension grade 1, without type 2 diabetes and nonobesity. The area under the receiver operating characteristic curve of this model was 0.841 [0.769-0.914]. Based on this model, the group of patients with a higher probability of cure (80.4%) were those without type 2 diabetes, BMI <30 kg/m 2 , female sex, hypertension grade 1 and who use two or fewer antihypertensives. Our predictive model offered a slightly higher diagnostic accuracy than Wachtel's (area under the curve [AUC]: 0.809), Utsumi's (AUC: 0.804) and Zarnegar's (AUC: 0.796) models and was similar than the Burello's (AUC: 0.833) model. Conclusion:Female sex, use of two or fewer antihypertensive medications, hypertension grade 1, no type 2 diabetes and nonobesity may predict hypertension cure after adrenalectomy in patients with PA. Our score provides a potential tool to guide preoperative patient counseling.

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Section: Discussionmentioning

confidence: 99%

Predictive model of hypertension resolution after adrenalectomy in primary aldosteronism: the SPAIN-ALDO score

Araujo-Castro

Fano

Boillos

et al. 2022

Journal of Hypertension

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“…However, for the PASO score and the Utsumi nomogram due to the relatively small number of external validation studies ( n < 4), we cannot draw definite conclusions regarding the generalizability and usefulness of these models in clinical practice. The ARS model is supported by stronger evidence compared with other scoring systems 13,14,17–21,31–41,43,48,49 and therefore we believe that it is an accurate and reliable prediction model which is the most user‐friendly and the least costly to identify long‐term high likelihood of CRH after adrenalectomy for UPA, particularly when adrenalectomy is adrenal vein sampling‐guided, regardless of imaging results 13 …”

Section: Discussionmentioning

confidence: 96%

Prognostic models to predict complete resolution of hypertension after adrenalectomy in primary aldosteronism: A systematic review and meta‐analysis

Marzano

Kazory

Husain‐Syed

et al. 2023

Clinical Endocrinology

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Complete resolution of hypertension (CRH) after adrenalectomy for primary aldosteronism is far from a certainty. Although several prognostic models have been proposed to predict outcome after adrenalectomy, studies have not clarified which of the available models can be used reliably in clinical practice. To identify, describe and appraise all prognostic models developed to predict CRH, and meta-analyse their predictive performances. We searched MEDLINE, Embase and Web of Science for development and validation studies of prognostic models. After selection, we extracted descriptive statistics and aggregated area under the receiver operator curve (AUC) using metaanalysis. From 25 eligible studies, we identified 12 prognostic models used for predicting CRH after total adrenalectomy in primary aldosteronism. We report the results for 3 models that had available data from at least 3 external validation studies: the primary aldosteronism surgical outcome (PASO) score

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“…The four-item aldosteronoma resolution score (ARS) using the regression coefficients of the Utsumi et al (2014) Japanese model has been shown to have superior accuracy. 10 Four preoperative clinical parameters including BMI, sex, duration of hypertension and number of preoperative antihypertensive medications are taken into account to calculate the ARS. 11 The use of predictive models, especially when there is low likelihood of biochemical/clinical success, and the diagnostic difficulty presented by localising unilateral PA should not be a deterrent to surgery.…”

Section: Discussionmentioning

confidence: 99%

The role of surgery in Conn's syndrome -a case of refractory hypertension secondary to an aldosterone secreting adenoma

Carides¹,

Sishuba

Bombil

et al. 2021

S. Afr. j. surg.

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SUMMARY Primary aldosteronism, eponymously known as Conn's syndrome, has recently gained recognition as the most common cause of endocrine hypertension. Unilateral subtypes, such as aldosterone secreting adenomas, are managed surgically and are potentially curable. The background of refractory hypertension and hypokalaemia in a forty-year-old man raised suspicions of Conn's syndrome which was localised to an aldosterone secreting adenoma in the right adrenal gland. The patient underwent a laparoscopic intraperitoneal right adrenalectomy which resulted in normalisation of his plasma aldosterone concentration as well as improved blood pressure control.

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Hypertension resolution after adrenalectomy for primary hyperaldosteronism: Which is the best predictive model?

Cited by 10 publications

References 25 publications

Predictive model of hypertension resolution after adrenalectomy in primary aldosteronism: the SPAIN-ALDO score

Predictive model of hypertension resolution after adrenalectomy in primary aldosteronism: the SPAIN-ALDO score

Prognostic models to predict complete resolution of hypertension after adrenalectomy in primary aldosteronism: A systematic review and meta‐analysis

The role of surgery in Conn's syndrome -a case of refractory hypertension secondary to an aldosterone secreting adenoma

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