Trends in blood pressure-related outcomes after adrenalectomy in patients with primary aldosteronism: A systematic review

Surgical Quality, Antihypertensive Therapy, and Electrolyte Balance: A Novel Trifecta to Assess Long-Term Outcomes of Adrenal Surgery for Unilateral Primary Aldosteronism

“…According to PASO criteria, the standardized composite outcome of adrenalectomy for UPA is represented by the concurrent attainment of normalization of blood pressure without the aid of antihypertensive medication and the absence of hypokalemia [8]. Even though the synchronous achievement of complete clinical and biochemical success remains a goal restricted to a minority of patients affected by UPA, the stiff thresholds considered as the intrinsic dichotomy of PASO criteria did not improve the historical heterogeneity in adrenalectomy outcomes reporting [5,9]. Since the incidence of electrolyte imbalance after adrenal gland removal remains negligible in the UPA setting, the decrease of blood pressure and/or the number of antihypertensive drugs remain the primary endpoint in most of contemporary adrenalectomy series [23,24].…”

“…Furthermore, whether the early achievement of PASO criteria after surgery may avoid a later onset of pHTN or hypokalemia remains unclear. [5] Recently, Vorselaars et al introduced the concept of "clinical cure," defining as clear improvement the normalization of blood pressure receiving a lower or equal number of antihypertensive medications [25][26][27]. The application of this system, however, could generate further issues since it provides neither clear information on antihypertensive dosage nor the evaluation of an eventual biochemical failure.…”

“…After adjusting our model for age, gender, adenoma size, surgical approach, and preoperative TIS score, on logistic univariable regression analysis, age (p = 0.04), AS (p = 0.04) and TIS ≥ score (p = 0.03) were significantly associated with trifecta achievement, while on multivariable analysis, TIS score ≥ 0.5 was the only independent predictor of trifecta achievement. As prior studies have described an established association between the number of preoperative drugs and normalization of blood pressure after adrenalectomy, it is reasonable to assume that higher preoperative TIS scores seem to be representative of patients affected by uncontrolled hypertension and, indirectly, with higher probability of early functional recovery after surgery [5,28]. Moreover, the relationship between age, adenoma size, and trifecta achievement on univariable analysis may remain clinically insignificant in the absence of major comorbidities, or it may represent a consequence of a regression model overfitting in our series (Table 4).…”

“…Although recent surveys showed a higher trend of performance toward general surgeons, minimally-invasive adrenalectomy (MIA) remains a procedure of interest to urologists [1][2][3][4]. Pathologic evaluations from large adrenalectomy series describe unilateral primary aldosteronism (UPA) as the most common benign adrenal disease with an estimated incidence ranging between 5-13% in the general population [5][6][7].…”

Recurrence of Primary Aldosteronism 10 Years After Left Adrenalectomy for Aldosterone-Producing Adenoma: A Case Report

“…Further research and more case reports are required to better elucidate the pathogenetic mechanism. In the clinic, patients are usually followed more frequently in the period immediately after adrenalectomy, but not in the long term (24). Furthermore, when patients were considered to have been "cured" based on the maintenance of BP without medication and by the correction of hypokalemia, the recurrence of hypertension is usually considered to be the onset of existing primary hypertension prompted by aging or others risk factors.…”