Primary Aldosteronism: Results of Adrenalectomy for Nonsingle Adenoma

Quillo, Amy R.; Grant, Clive S.; Thompson, Geoffrey B.; Farley, David R.; Richards, Melanie L.; Young, William F.

doi:10.1016/j.jamcollsurg.2011.03.007

Cited by 28 publications

(25 citation statements)

References 31 publications

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“…This rate of BP normalization was associated with correction of the biochemical picture of PA in practically all of our surgically treated patients, which renders our results comparable with the 98% cure rate reported at Mayo Clinic using a definition of cure that included either biochemical normalization of aldosterone or normalization of BP. 41 In contrast with the outcome of the adrenalectomized patients, the medically treated PA patients and those with primary hypertension showed an increase over time of the antihypertensive treatment needed to achieve BP control ( Figure S2). Thus, on the whole these findings indicate that a precise early diagnosis is a key for achieving control of BP and tapering the antihypertensive treatment.…”

Section: Effect Of Correction Of Hyperaldosteronismmentioning

confidence: 93%

Long-Term Control of Arterial Hypertension and Regression of Left Ventricular Hypertrophy With Treatment of Primary Aldosteronism

et al. 2013

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P rimary aldosteronism (PA) is a common curable cause of high blood pressure (BP).1 PA is of peculiar interest because the excess aldosterone secretion is held to be autonomous from angiotensin II, which allows elucidating the cardiovascular effects of excess aldosterone without the confounding effects of excess angiotensin II. Moreover, as the excess of aldosterone is cured with adrenalectomy in practically all patients, 2 causation between aldosterone excess and the cardiovascular changes could be inferred. However, whether surgery or pharmacological blockade of the mineralocorticoid receptor (MR) warrant cure of high BP and regression of cardiovascular damage, and of cardiac remodeling, at long term remains unclear because limited data exist. 3,4 The adaption of the left ventricle (LV) to the increased afterload of patients with high BP involves development of hypertrophy (LVH), which predicts cardiovascular events and death, 5 and when regressed improved prognosis. 6 In the complex interplay of hemodynamic, genetic, and endocrine-paracrine factors that underlie development of LVH aldosterone plays a pivotal role. [7][8][9] In the setting of a high sodium intake, this major effector of the system causes LVH, transcription of collagen type I and III genes, 10 and promotes fibroblasts proliferation, oxidative stress, and inflammation, 11 in part, by potentiating the effects of angiotensin II on AT-1 receptors.12-15 These actions, alongside the effects of the steroid on pre-and after-load, are held to cause inflammation and fibrosis, which contribute to worsening prognosis of patients with hyperaldosteronism, 8,16 and can explain the survival benefit conferred by MR antagonists to optimally treated patients with LV systolic dysfunction. 17,18 Compared with BP-matched primary (essential) hypertensive patients, those with PA have an excess LVH and a LV mass inappropriately high for the degree of LV workload and BP elevation. [2][3][4]9,[19][20][21][22][23][24][25][26][27][28] Cardiac fibrosis with ensuing altered LV diastolic dysfunction can lead to left atrium dilatation and increased risk of atrial fibrillation (AF) 7,8,29 ; whether these changes regress with specific treatment for PA remains uncertain. 3,4,19,20,26 We, therefore, set out to prospectively investigate the long-term effects of correction of hyperaldosteronism on BP, LV mass, and cardiovascular events in a large cohort of patients with PA.Abstract-Primary aldosteronism (PA), a common cause of high blood pressure (BP), induces left ventricular (LV) hypertrophy and an excess rate of cardiovascular events. Whether its treatment provides long-term cure of hypertension and regression of cardiovascular damage remains uncertain. To the aim of assessing the effect of treatment of PA on BP and LV changes, we prospectively recruited 323 patients in a long-term follow-up study entailing serial echocardiography evaluations. Of them, 180 had PA and were assigned to either adrenalectomy (n=110) or medical therapy (n=70)

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Section: Effect Of Correction Of Hyperaldosteronismmentioning

confidence: 93%

Long-Term Control of Arterial Hypertension and Regression of Left Ventricular Hypertrophy With Treatment of Primary Aldosteronism

et al. 2013

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“…Cure of hypertension occurs in 30% to 60% of patients with PA, 5,6,[24][25][26][27]62 and predictive factors for persistent hypertension include age, number of antihypertensive medications, duration of hypertension, obesity, and vascular remodeling. [24][25][26][27][62][63][64][65] In a young patient with hypokalemia and with difficulty to control hypertension of recent onset, the potential for significant impact of surgical cure of PA is high. In addition, unilateral adrenalectomy can be beneficial in some patients with bilateral aldosterone production, 66 which cautions against reliance on cross-sectional imaging with CT and MRI when AVS is equivocal.…”

Section: Clinical Decision Making Based On Equivocal Avs Resultsmentioning

confidence: 99%

An Expert Consensus Statement on Use of Adrenal Vein Sampling for the Subtyping of Primary Aldosteronism

et al. 2014

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Abstract-Adrenal venous sampling is recommended by current guidelines to identify surgically curable causes of hyperaldosteronism but remains markedly underused. Key factors contributing to the poor use of adrenal venous sampling include the prevailing perceptions that it is a technically challenging procedure, difficult to interpret, and can be complicated by adrenal vein rupture. In addition, the lack of uniformly accepted standards for the performance of adrenal venous sampling contributes to its limited use. Hence, an international panel of experts working at major referral centers was assembled to provide updated advice on how to perform and interpret adrenal venous sampling. To this end, they were asked to use the PICO (Patient or Problem, Intervention, Control or comparison, Outcome) strategy to gather relevant information from the literature and to rely on their own experience. The level of evidence/recommendation was provided according to American Heart Association gradings whenever possible. A consensus was reached on several key issues, including the selection and preparation of the patients for adrenal venous sampling, the procedure for its optimal performance, and the interpretation of its results for diagnostic purposes even in the most challenging

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“…12, 13 The presence of multiple nodules in an adrenal cortex often is interpreted as being composed of multiple adenomas or nodular hyperplasia. 14 Most APAs also exhibit zona glomerulosa hyperplasia, 15 but this is open to histological interpretations as some groups describe that this is seldom seen. 16 Nevertheless, since HE staining provides no information on the functional phenotype, whether the nodule(s) is responsible for the over-production of aldosterone remains uncertain.…”

Section: Introductionmentioning

confidence: 99%