Unilateral primary aldosteronism considerations about the diagnostic criteria, adrenalectomy, and short and long time biochemical and clinical evaluation

Abstract

The study by Yan and co-workers 1 sought to review the literature reports on diagnostic criteria and biochemical and clinical success after surgery in patients with unilateral hyperaldosteronism. Primary aldosteronism is a syndrome, that includes various pathologies that have certain signs and symptoms in common. Since the discovery of the disease, many studies have tried to establish the criteria for diagnosis and operability of unilateral forms. With the availability of computerized tomography (CT) and magnetic resonance (MRI) and with the advance in methods to evaluate selective aldosterone secretion in the adrenal veins (AVS), the criteria have been refined and numerous guidelines have been made by various societies. The initial guidelines of the Endocrine Society and the Japan Endocrine Society 2,3 recommend AVS in all patients diagnosed with primary aldosteronism who are willing to have surgery when necessary. Subsequently, new guidelines considered that in some cases catheterization was not necessary if an adenoma was evident in a young patient with low serum potassium. 4 The modification of the guidelines demonstrates that many points remain unclear and may influence the follow-up after unilateral adrenalectomy. The difficulty to create homogeneous guidelines is probably related to the fact that primary aldosteronism is a syndrome and not a defined disease with numerous underlying factors (genetic, autoimmune, family, etc.). 5 The Primary Aldosteronism Surgical Outcome (PASO) study 6 emphasized that the duration of hypertension is a key factor in both the outcome of the intervention of future cardiovascular risk. EstablishingThis is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.