Long-term outcome success after operative treatment for primary aldosteronism

Picado, Omar; Whitfield, Bryan W.; Khan, Zulfia; Jeraq, Mohammed; Farrá, Josefina C.; Lew, John I.

doi:10.1016/j.surg.2020.07.046

Cited by 14 publications

(6 citation statements)

References 23 publications

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“…Picado et al [24] have reported complete, partial, and absent clinical success achieved in 41%, 38%, and 21% of patients with PA at 6 months post-operation, respectively. High pre-operative [8] and post-operative blood pressure, longstanding hypertension, high BMI, and post-operative plasma aldosterone levels are predictive of post-operative long-term hypertension.…”

Section: Discussionmentioning

confidence: 96%

Clinical Features and Etiology of Recurrent Hypertension after Adrenalectomy

Dong,

Ling,

Bian

et al. 2024

CVIA

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Patients who undergo adrenalectomy for unilateral primary aldosteronism (PA) may still develop post-surgery hypertension; however, the clinical characteristics and etiology of patients developing recurrent hypertension after adrenalectomy are unclear. We analyzed the records of 43 patients with recurrent elevated blood pressure after adrenalectomy, who were treated at our center. Standard routine clinical screening workup was used to identify the cause of recurrent hypertension. Causes of recurrent hypertension after adrenalectomy included essential hypertension, primary aldosteronism, obstructive sleep apnea, renal artery stenosis, and Takayasu arteritis. Before adrenalectomy, 39.5% of patients were diagnosed with confirmed or suspected PA, primarily through CT imaging. Adrenal venous sampling (AVS) tests were not conducted on any patients, and 72.1% patients underwent partial adrenalectomy. Among all patients, elevated blood pressure was observed in 44.2% immediately post-operation, 18.6% within 1 month, 16.3% in 1–6 months, and 20.9% >6 months after operation. Most patients had hypertension of grade 2 and above. Standard endocrine functional assessment and AVS tests should be performed before adrenalectomy to ensure more accurate diagnosis and favorable post-operative outcomes. Additionally, individuals often develop essential hypertension regardless of past adrenal disease.

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Section: Discussionmentioning

confidence: 96%

Clinical Features and Etiology of Recurrent Hypertension after Adrenalectomy

Dong,

Ling,

Bian

et al. 2024

CVIA

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“…Similarly, Picado, et al. ( 39 ) used the PASO consensus to assess long-term outcomes in 37 patients with PA who underwent adrenalectomy and to identify preoperative predictors associated with persistent postoperative hypertension. The results showed complete biochemical success in all patients, while clinical outcomes were complete success 15 (41%), partial success 14 (38%) and absent success 8 (21%).…”

Section: Factors Affecting Prognosismentioning

confidence: 99%

Adrenalectomy for primary aldosteronism and its related surgical characteristics

Xiang,

Zhang,

Song

et al. 2024

Front. Endocrinol.

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Primary aldosteronism (PA) is a common cause of secondary hypertension. Adrenalectomy is an effective treatment for unilateral PA, particularly aldosterone-producing adenoma (APA), resulting in improvements in biochemical parameters and blood pressure in the vast majority of patients. The article provides a comprehensive overview of PA, focusing on the outcomes of adrenalectomy for PA and the factors that may suggest prognostic implications. Analysis of the outcome of different PA patients undergoing adrenalectomy in terms of preoperative factors, vascular and adipose conditions, type of pathology, and somatic variants. In addition, it is recommended to use the histopathology of primary aldosteronism (HISTALDO) consensus to classify the patient’s pathological type, with classical and nonclassical pathological types showing a different prognosis and possibly being associated with an unresected contralateral adrenal gland. The primary aldosteronism surgical outcome (PASO) consensus sets uniform standards for postoperative outcomes in unilateral PA, but its setting of thresholds remains controversial. Partial adrenalectomy shows similar surgical results and fewer postoperative complications than total adrenalectomy, but there is a risk of missing the true source of abnormal aldosterone secretion. Steroid profiling and functional imaging techniques offer alternative options to adrenal vein sampling (AVS) for unilateral and bilateral judgments in patients with PA. A combination of factors is needed to predict the prognosis of PA patients undergoing adrenalectomy in order to manage patient expectations of the outcome of the procedure and to closely monitor blood pressure and biochemical parameters in patients who suggest a poorer prognosis.

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“…Therefore, 84% of patients experienced either cure or significant improvement in blood pressure control with adrenalectomy. Reported rates of complete cure of hypertension following adrenalectomy for unilateral PA have ranged from 20-66% ( 55 , 57 , 58 , 65 , 67 – 71 ). These studies show that the vast majority of patients who do not achieve complete cure still have a significant improvement in blood pressure control as demonstrated by reduced blood pressure readings and/or reduced antihypertensive medication requirements.…”

Section: Clinical Outcomes Following Surgical Adrenalectomy For Unila...mentioning

confidence: 99%

Benefits of Surgical Over Medical Treatment for Unilateral Primary Aldosteronism

Ahmed

Hundemer

2022

Front. Endocrinol.

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Primary aldosteronism is the most common and modifiable form of secondary hypertension. Left untreated, primary aldosteronism leads high rates of cardiovascular, metabolic, and kidney disease. Therefore, early diagnosis and targeted therapy are crucial to improve long-term patient outcomes. In the case of unilateral primary aldosteronism, surgical adrenalectomy is the guideline-recommended treatment of choice as compared to alternative medical therapies such as mineralocorticoid receptor antagonist medications. Surgical adrenalectomy is not only highly successful in reversing the biochemical abnormalities inherent to primary aldosteronism, but also in mitigating the long-term risks associated with this disease. Indeed, as opposed to medical treatment alone, surgical adrenalectomy offers the potential for disease cure. Within this review article, we review the existing evidence highlighting the benefits of surgical over medical treatment for unilateral primary aldosteronism.

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Long-term outcome success after operative treatment for primary aldosteronism

Cited by 14 publications

References 23 publications

Clinical Features and Etiology of Recurrent Hypertension after Adrenalectomy

Clinical Features and Etiology of Recurrent Hypertension after Adrenalectomy

Adrenalectomy for primary aldosteronism and its related surgical characteristics

Benefits of Surgical Over Medical Treatment for Unilateral Primary Aldosteronism

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