Outcomes analysis of surgical and medical treatments for patients with primary aldosteronism

Park, Kyeong Seon; Kim, Jung Hee; Yang, Ye; Hong, A Ram; Lee, Dong Hwa; Moon, Min Kyong; Choi, Sung Hee; Shin, Chan Soo; Kim, Sang Wan; Kim, Seong Yeon

doi:10.1507/endocrj.ej16-0530

Cited by 19 publications

(20 citation statements)

References 23 publications

(41 reference statements)

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“…The more correction of hyperaldosteronism in those with lower CSI may lead to a stronger reduction in the relative glomerular hyperfiltration, as proposed by Sechi et al’s studies [ 16 , 17 ]. On the other hand, our previous study showed that surgical and medical treatment provided similar amelioration of hypokalemia and hypertension; however, there was a greater decrease in GFR and higher serum potassium levels in the surgical treatment group than in the medical treatment group in patients with PA who were aged >60 years [ 18 ]. Another retrospective study showed that the GFR declined in the 6 months after the treatments—both adrenalectomy and medical treatment—however, long-term annual decline in GFR and risk for incident CKD were not significantly different between the patients with unilateral adrenalectomy and those with essential hypertension patient [ 13 ].…”

Section: Discussionmentioning

confidence: 99%

Contralateral Suppression at Adrenal Venous Sampling Is Associated with Renal Impairment Following Adrenalectomy for Unilateral Primary Aldosteronism

et al. 2021

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Background: Adrenal venous sampling (AVS) is performed to distinguish the subtype of primary aldosteronism (PA). The clinical implication of contralateral suppression (CS; aldosterone/cortisolnondominant<aldosterone/cortisolperipheral) at AVS remains unclear. We aimed to investigate the clinical significance of CS and its impact on postoperative outcomes after unilateral adrenalectomy. Methods: In this retrospective observational multi-center study, we analyzed PA patients who underwent both successful adrenocorticotropin hormone-stimulated AVS and unilateral adrenalectomy. Successful cannulation was defined as the selectivity index (cortisoladrenal/ cortisolperipheral) ≥3. Clinical and biochemical outcomes after unilateral adrenalectomy were evaluated based on the international Primary Aldosteronism Surgical Outcome consensus.Results: Among 263 patients analyzed, 247 had CS (93.9%). Patients with CS had lower serum potassium levels, higher plasma aldosterone concentration, higher aldosterone-to-renin ratio (ARR), and larger adenoma size than those without CS. Those with CS showed significantly higher lateralization index than those without CS (P<0.001). Although postoperative blood pressure and ARR significantly decreased in those with CS, clinical and biochemical outcomes were comparable in both groups. When the cut-off value of age was determined using receiver operating characteristic (ROC) analysis, patients aged ≥50 years old with contralateral suppression index (CSI; the ratio between aldosterone/cortisolnondominant and aldosterone/cortisolperipheral) ≤0.26 had greater odds ratio (6.43; 95% confidence interval, 1.30 to 31.69) of incident chronic kidney disease than those aged <50 years with CSI >0.26 after adjusting for other factors.Conclusion: CS may not predict postoperative clinical and biochemical outcomes in subjects with unilateral aldosterone excess, but it is associated with postsurgical deterioration of renal function in subjects over 50 years with CSI ≤0.26.

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Section: Discussionmentioning

confidence: 99%

Contralateral Suppression at Adrenal Venous Sampling Is Associated with Renal Impairment Following Adrenalectomy for Unilateral Primary Aldosteronism

et al. 2021

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“…5 Several studies have reported that a significant proportion of patients with PA, which is characterized as the excessive secretion of mineralocorticoids, showed decreased renal function after unilateral adrenalectomy. [6][7][8][9][10][11][12] This decreased renal function was assumed to be masked renal impairment as a result of the cancellation of glomerular hyperfiltration caused by hyperaldosteronism. 6,7 Considering the mineralocorticoid activity of cortisol, it is conceivable that correcting high cortisol levels with adrenalectomy might also cause renal impairment in patients with CS.…”

Section: Introductionmentioning

confidence: 99%

“…A recent report suggests that, depending on the intracellular redox state, cortisol might have a bivalent effect, even at physiological concentrations . Several studies have reported that a significant proportion of patients with PA, which is characterized as the excessive secretion of mineralocorticoids, showed decreased renal function after unilateral adrenalectomy . This decreased renal function was assumed to be masked renal impairment as a result of the cancellation of glomerular hyperfiltration caused by hyperaldosteronism .…”

Section: Introductionmentioning

confidence: 99%

Postoperative renal impairment and longitudinal change in renal function after adrenalectomy in patients with Cushing's syndrome

et al. 2020

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Abbreviations & Acronyms ACTH = adrenocorticotropic hormone BP = blood pressure CI = confidence interval CS = Cushing's syndrome eGFR = estimated glomerular filtration rate GFR = glomerular filtration rate HPA = hypothalamicpituitary-adrenal PA = primary aldosteronism SCS = subclinical Cushing's syndrome Correspondence: MinatoObjectives: To evaluate the renal function after adrenalectomy in patients with Cushing's syndrome in comparison with that in patients with primary aldosteronism. Methods: This retrospective study included 35 patients with Cushing's syndrome and 51 patients with primary aldosteronism who underwent unilateral adrenalectomy and were followed up for >6 months. The renal function was analyzed before and after adrenalectomy using the estimated glomerular filtration rate. Postoperative renal impairment was defined as a >25% reduction in the estimated glomerular filtration rate from baseline at 1 month after adrenalectomy. Multivariate logistic regression analyses were carried out to examine whether the differences between Cushing's syndrome and primary aldosteronism increased the risk of postoperative renal impairment. Longitudinal changes were calculated starting 1 month after adrenalectomy using the linear mixed model. Results: The mean estimated glomerular filtration rate in both groups significantly decreased at 1 month after adrenalectomy from baseline. Postoperative renal impairment was observed in four (11%) and 12 (24%) patients in the Cushing's syndrome and primary aldosteronism groups, respectively. Multivariate analysis showed that preoperative systolic blood pressure was independently associated with postoperative renal impairment, but not with the type of the disease. There was no significant increase or decrease in postoperative estimated glomerular filtration rate observed after the initial decrease after adrenalectomy in either group. Conclusions: Patients with Cushing's syndrome show the same persistent renal impairment after adrenalectomy as that reported in patients with primary aldosteronism. Attention should be given to possible masked renal damage in clinical practice for the management of Cushing's syndrome.

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“…The other four studies included PA patients who were both treated by surgery and/or mineralocorticoid receptor antagonists. Longitudinal studies and meta-analyses have compared the longterm outcomes of surgical and medical treatments for patients with PA (24)(25)(26). Their findings suggested that for patients with PA, surgical treatment leads to better hypertension and hypokalemia outcomes compared to medical treatment.…”

Section: Discussionmentioning

confidence: 99%

Long-Term Mortality for Patients of Primary Aldosteronism Compared With Essential Hypertension: A Systematic Review and Meta-Analysis

et al. 2020

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Background: Consistent evidence have demonstrated that patients with primary aldosteronism (PA) have higher risk of cardiovascular events to patients with essential hypertension (EH). Whether the long-term risk of mortality for PA patients is higher than EH patients is unclear. We aim to compare the long-term mortality of patients with PA to patients with EH. Methods: We searched PubMed, Embase, and Cochrane Central Register of Controlled Trials for eligible studies from inception to 14 Nov 2018. We combined the relative risks (RR) of each included study by random-effect model. The amount of between study heterogeneity was measured by the I 2 statistic. Results: We totally included six studies with cohort design, including 3,039 PA and 45,495 EH patients. The pooled RRs for patients with PA were 1.97 (95%CI: 1.33, 2.91; P = 0.0007) for a follow-up of 3 years, 0.96 (95%CI: 0.75, 1.23; P = 0.76) for 5 years, 0.86 (95%CI: 0.51, 1.46) for 7.5 years, and 0.95 (95%CI: 0.61, 1.48; P = 0.58) for 10 years. For patients with aldosterone-producing adenomas (APA), evidence of lower risk of long-term mortality was observed. Our sensitivity analysis suggested our results were stable. Conclusions: Current evidence supported a higher risk of mortality for patients with primary aldosteronism at 3 years compared to patients with essential hypertension, however this risk no longer sustains as the follow-up time increased to 5 or more years. Patients with aldosterone-producing adenomas may have lower long-term mortality rate than patients with essential hypertension due to the better recovery of adrenalectomy.

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Outcomes analysis of surgical and medical treatments for patients with primary aldosteronism

Cited by 19 publications

References 23 publications

Contralateral Suppression at Adrenal Venous Sampling Is Associated with Renal Impairment Following Adrenalectomy for Unilateral Primary Aldosteronism

Contralateral Suppression at Adrenal Venous Sampling Is Associated with Renal Impairment Following Adrenalectomy for Unilateral Primary Aldosteronism

Postoperative renal impairment and longitudinal change in renal function after adrenalectomy in patients with Cushing's syndrome

Long-Term Mortality for Patients of Primary Aldosteronism Compared With Essential Hypertension: A Systematic Review and Meta-Analysis

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