Outcomes in unilateral primary aldosteronism after surgical or medical therapy

Puar, Troy; Loh, L.; Loh, Wann Jia; Lim, Dawn Shao Ting; Zhang, Meifen; Tan, Pei Ting; Lee, Lynette; Swee, Du Soon; Khoo, Joan; Tay, Donovan; Tan, Sarah Ying Tse; Zhu, Ling; Gani, Linsey; King, Thomas H.; Kek, Peng Chin; Foo, Roger

doi:10.1111/cen.14351

Cited by 14 publications

(21 citation statements)

References 36 publications

(76 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…We also found that some improvements were noted only after 1 year post-treatment. This suggests that improvements in HRQoL may extend beyond the initial 3–6 months similar to other beneficial effects such as blood pressure of which improvement might not be observed immediately upon treatment ( 28 ).…”

Section: Discussionmentioning

confidence: 99%

“…However, it is uncommon for patients with unilateral PA to be treated with medications, precluding this comparison. We previously compared treatment outcomes in only patients with unilateral PA and found better blood pressure outcomes with surgery ( 28 ). Thirdly, our cohort was relatively small and may have been underpowered to assess for differences between treatment groups.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Improvement in quality of life and psychological symptoms after treatment for primary aldosteronism: Asian Cohort Study

Tan

Kwan

Teo

et al. 2021

Endocrine Connections

Self Cite

View full text Add to dashboard Cite

Background: In addition to increased cardiovascular risk, patients with primary aldosteronism (PA) also suffer from impaired health–related quality of life (HRQoL) and psychological symptoms. We assessed for changes in HRQoL and depressive symptoms in a cohort of Asian patients with PA, after surgical and medical therapy. Methods: 34 patients with PA were prospectively recruited and completed questionnaires from 2017 to 2020. HRQoL was assessed using RAND–36 and EQ–5D–3L, and depressive symptoms were assessed using Beck Depression Inventory (BDI–II) at baseline, 6 months, and 1 year post–treatment. Results: At 1 year post–treatment, significant improvement was observed in both physical and mental summative scores of RAND–36, +3.65, P=0.023, and +3.41, P=0.033, respectively, as well as four subscale domains (physical functioning, bodily pain, role emotional and mental health). Significant improvement was also seen in EQ–5D dimension of anxiety/depression at 1 year post–treatment. Patients treated with surgery (N=21) had significant improvement in EQ–5D index score post–treatment, and better EQ–5D outcomes compared to medical group (N=13) at 1 year post–treatment. 37.9%, 41.6% and 58.6% of patients had symptoms in the cognitive, affective and somatic domains of BDI–II respectively. There was significant improvement in the affective domain of BDI–II at 1 year post–treatment. Conclusion: Both surgical and medical therapy improve HRQoL and psychological symptoms in patients with PA, with surgery providing better outcomes. This highlights the importance of early diagnosis, accurate subtyping and appropriate treatment of PA.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Improvement in quality of life and psychological symptoms after treatment for primary aldosteronism: Asian Cohort Study

Tan

Kwan

Teo

et al. 2021

Endocrine Connections

Self Cite

View full text Add to dashboard Cite

show abstract

“…Eplerenone treatment has been shown in animal models to reduce the aldosterone-induced damage to the cerebral cortex ( 35 ). In our retrospective cohort, 14 of our 154 (9%) patients with PA had a prior diagnosis of CVA ( 36 ). Hence, while there should be sustained efforts in the early diagnosis and treatment of PA, the event of a stroke should prompt clinicians to consider screening for secondary causes, particularly in patients with good functional recovery.…”

Section: Discussionmentioning

confidence: 99%

Primary Aldosteronism More Prevalent in Patients With Cardioembolic Stroke and Atrial Fibrillation

Nguyen

Mamauag

et al. 2022

Front. Endocrinol.

Self Cite

View full text Add to dashboard Cite

BackgroundPrimary aldosteronism (PA) is the most common cause of secondary hypertension, and patients are at an increased risk of atrial fibrillation (AF) and stroke. We assessed the prevalence of PA in patients with recent stroke.MethodsWe recruited 300 patients admitted to an acute stroke unit with diagnosis of cerebrovascular accident (haemorrhagic/ischaemic) or transient ischaemic attack. Three months post-stroke, plasma renin and aldosterone were measured. Patients with an elevated aldosterone–renin ratio proceeded to the confirmatory saline loading test.ResultsTwenty-six of 192 (14%) patients had an elevated aldosterone–renin ratio. Three of 14 patients who proceeded to saline loading were confirmed with PA (post-saline aldosterone >138 pmol/l). Another three patients were classified as confirmed/likely PA based on the markedly elevated aldosterone–renin ratio and clinical characteristics. The overall prevalence of PA amongst stroke patients with hypertension was 4.0% (95% confidence interval (CI): 0.9%–7.1%). Prevalence of PA was higher amongst patients with cardioembolic stroke, 11% (95% CI: 1.3%–33%), resistant hypertension, 11% (95% CI: 0.3%–48%), and hypertension and AF, 30% (95%CI: 6.7%–65%). If only young patients or those with hypokalaemia were screened for PA, half of our patients with PA would not have been diagnosed. Our decision tree identified that stroke patients with AF and diastolic blood pressure ≥83mmHg were most likely to have PA.ConclusionWe found that amongst hypertensive patients with stroke, PA was more prevalent in those with AF, or cardioembolic stroke. Screening for PA should be considered for all patients with stroke.

show abstract

“…In the Primary Aldosteronism Surgical Outcome (PASO) study (33), which included relevant data of 705 PA patients who underwent adrenalectomy, the prevalence rate of complete ("normal blood pressure without the aid of antihypertensive medication") and partial ("the same blood pressure with less antihypertensive medication or a reduction in blood pressure with either the same amount or less antihypertensive medication") clinical success was summed up as high as 84.2%, together with 93.9% biochemical success, which refers to "correction of hypokalemia and normalization of aldosterone to renin ratio (ARR)". In this meta-analysis, the percentage of PA patients with hypertension cured after surgical treatment was higher than that with medical treatment (73.98% vs 68.08%).…”

Section: Discussion Main Findingsmentioning

confidence: 99%

“…Among them, 32 did not show relevant data, while other 15 articles reported outcomes nonuniformly with regard to the target treatments. Finally, 12 studies (6,10,18,20,(25)(26)(27)(28)(29)(30)(31)(32) were included in this meta-analysis (Figure 1), resulting in a total of 6148 PA patients who received either surgical (35.98%) or medical treatment (64.02%). The descriptive summary for each included study was recapitulated in Table 1.…”

Section: Included Studiesmentioning

confidence: 99%

Composite Cardiovascular Outcomes in Patients With Primary Aldosteronism Undergoing Medical Versus Surgical Treatment: A Meta-Analysis

et al. 2021

View full text Add to dashboard Cite

BackgroundSuperior outcomes after surgical treatment over medical treatment for primary aldosteronism (PA) has been reported in small-scale clinical studies, but no solid conclusion has been drawn as results of large randomized trials are lacking.MethodsWe performed a search of PubMed, MEDLINE, Embase and Cochrane Library for randomized or observational studies that investigated cardiovascular outcomes in patients with PA undergoing medical versus surgical treatment. Meta-analyses of both composite and individual outcomes were conducted. Risks of bias of the included studies were assessed with Risk Of Bias In Non-randomized Studies of Interventions (ROBINS-I) checklist. Trial sequential analysis (TSA) was performed to control the risk of random errors and assess whether the results in our meta-analysis were conclusive.ResultsA total of 12 studies, including a total of 6148 PA patients, were included in the meta-analysis. The results of meta-analyses demonstrated lower incidence of composite cardiovascular outcomes among PA patients who underwent surgical treatment over medical treatment (odds ratio (OR): 0.49). Surgical treatment also led to less incidence of persistence of hypertension (OR of non-cure hypertension: 0.31). Fewer major cardiovascular events and mortality events were observed (OR: 0.60) after surgical treatment. TSA result showed that the required information size was 2151 and the cumulative Z curve crossed the futility boundary and reached the required information size.ConclusionSuperior performance of surgical treatment over medical treatment is confirmed with meta-analyses in terms of lower incidences of composite cardiovascular outcomes and non-cure of hypertension. Hence, adrenalectomy could now be concluded as the treatment of choice for lateralized PA.

show abstract

Outcomes in unilateral primary aldosteronism after surgical or medical therapy

Cited by 14 publications

References 36 publications

Improvement in quality of life and psychological symptoms after treatment for primary aldosteronism: Asian Cohort Study

Improvement in quality of life and psychological symptoms after treatment for primary aldosteronism: Asian Cohort Study

Primary Aldosteronism More Prevalent in Patients With Cardioembolic Stroke and Atrial Fibrillation

Composite Cardiovascular Outcomes in Patients With Primary Aldosteronism Undergoing Medical Versus Surgical Treatment: A Meta-Analysis

Contact Info

Product

Resources

About