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Hypertension outcomes of adrenalectomy for unilateral primary aldosteronism

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Abstract

Purpose

To evaluate laboratory and clinical results after unilateral adrenalectomy in patients with primary aldosteronism (PHA).

Methods

A cross-sectional analysis was performed using data from patients who underwent transperitoneal laparoscopic adrenalectomy for PHA, between January 2008 and December 2019. Surgical indications were based on adrenal venous sampling without ACTH stimulation. Analyses included patient demographics; preoperative clinical, pharmacological, laboratory, and radiological data; and postoperative results assessed after a median of 4 months. Antihypertensive drug use was quantified by estimating the daily defined dose (DDD) of antihypertensive medication, thus enabling standardized comparison of dosage between the drug classes. Statistical assessments included univariable and multivariable logistic regression analysis.

Results

This study enrolled 87 patients. The patients were taking 5.4 DDD of antihypertensive medication before surgery, and 3.0 DDD after surgery. Complete biochemical success of surgery was reached 67 patients (77%), 19 patients (22%) had partial biochemical success. Complete clinical success with normalization of blood pressure and withdrawal of all antihypertensive drugs was achieved in 19 patients (22%). 57 patients (65%) exhibited a reduction of DDD after surgery and/or improvement of blood pressure—partial clinical success. Thus, in 76 (87%) of all enrolled patients, surgery had an overall positive effect on hypertension control. Multivariable logistic regression showed that complete clinical success was independently associated with female gender and baseline sum of antihypertensive drugs DDD < 4.

Conclusion

A majority of patients undergoing unilateral adrenalectomy for PHA achieved markedly improved hypertension control, despite almost halving their antihypertensive medication. Almost a quarter of patients were cured and able to cease using all antihypertensive drugs.

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References

  1. A. Hannemann, H. Wallaschofski, Prevalence of primary aldosteronism in patient’s cohorts and in population-based studies – a review of the current literature. Horm. Metab. Res. 44, 157–162 (2012)

    Article  CAS  Google Scholar 

  2. J.W. Funder, R.M. Carey, F. Mantero et al. The management of primary aldosteronism: case detection, diagnosis, and treatment: An endocrine society clinical practice guideline. J. Clin. Endocrinol. Metab. 101, 1889–1916 (2016)

    Article  CAS  Google Scholar 

  3. J.M. Brown, M. Siddiqui, D.A. Calhoun et al. The unrecognized prevalence of primary aldosteronism: a cros-sectional study. Ann. Intern. Med. 173(1), 10–20 (2020)

    Article  Google Scholar 

  4. M. Parasiliti-Capriamo, C. Lopez, N. Prencipe et al. Prevalence of primary aldosteronism and association with cardiovascular complications in patients with resistant and refractory hypertension. J. Hypertens. 38(9), 1841–8 (2020)

    Article  Google Scholar 

  5. G.L. Hundemer, G.C. Curhan, N. Yozamp et al. Renal outcomes in medically and surgically treated primary aldosteronism. Hypertension 72, 658–66 (2018)

    Article  CAS  Google Scholar 

  6. Z.W. Chen, C.S. Hung, V.C. Wu et al. Primary aldosteronism and cerebrovascular diseases. Endocrinol. Metab. 3, 429–34 (2018)

    Article  Google Scholar 

  7. B.K. Goh, Y.A. Tan, K.T. Chang et al. Primary hyperaldosteronism secondary to unilateral adrenal hyperplasia: an unusual cause of surgically correctable hypertension. A review of 30 cases. World J. Surg. 31(1), 72–9 (2007)

    Article  Google Scholar 

  8. P. Milliez, X. Girerd, P.F. Plouin et al. Evidence for an increased rate of cardiovascular events in patients with primary aldosteronism. J. Am. Coll. Cardiol. 45, 1243–48 (2005)

    Article  CAS  Google Scholar 

  9. F. Lumachi, M. Ermani, S.M. Basso et al. Long-term results of adrenalectomy in patients with aldosterone-producing adenomas: multivariate analysis of factors affecting unresolved hypertension and review of the literature. Am. Surg. 71(10), 864–9 (2005)

    Article  Google Scholar 

  10. M. Omura, H. Sasano, J. Saito et al. Clinical characteristics of aldosterone-producing microadenoma, macroadenoma, and idiopathic hyperaldosteronism in 93 patients with primary aldosteronism. Hypertens. Res. 29(11), 883–9 (2006)

    Article  CAS  Google Scholar 

  11. A. Toniato, P. Bernante, G.P. Rossi et al. The role of adrenal venous sampling in the surgical management of primary aldosteronism. World J. Surg. 30, 624–627 (2006)

    Article  Google Scholar 

  12. T. Nishikawa, M. Omura, F. Satoh et al. Guidelines for the diagnosis and treatment of primary aldosteronism. Task Force Committee on Primary Aldosteronism, The Japan Endocrine Society. Endocr. J. 58(9), 711–721 (2011)

    Article  CAS  Google Scholar 

  13. W.F. Young, A.W. Stanson, G.B. Thompson et al. Role for adrenal venous sampling in primary aldosteronism. Surgery 136, 1227–1235 (2004)

    Article  Google Scholar 

  14. B. Williams, G. Mancia, W. Spiering et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension: The Task Force for the management of arterial hypertension of the European Society of Cardiology and the European Society of Hypertension: The Task Force for the management of arterial hypertension of the European Society of Cardiology and the European Society of Hypertension. J. Hypertens. 36(10), 1953–2041 (2018)

    Article  CAS  Google Scholar 

  15. T. Unger, C. Borghi, F. Charchar et al. 2020 International Society of Hypertension global hypertension practice guidelines. J. Hypertens. 38(6), 982–1004 (2020)

    Article  CAS  Google Scholar 

  16. WHO Collaborating Centre for Drug Statistics Methodology, Guidelines for ATC classification and DDD assignment 2013. Oslo (2012).

  17. R. Modolo, A.P. de Faria, A.M. Ritter et al. Defined daily dose (DDD) and its potential use in clinical trials of resistant hypertension. Int. J. Cardiol. 202, 515–6 (2016)

    Article  Google Scholar 

  18. T.A. Williams, J.W.M. Lenders, P. Mulatero et al. Primary Aldosteronism Surgery Outcome (PASO) investigators. Outcomes after adrenalectomy for unilateral primary aldosteronism: an international consensus on outcome measures and analysis of remission rates in an international cohort. Lancet Diabetes Endocrinol. 5(9), 689–699 (2017)

    Article  Google Scholar 

  19. Y. Zhou, M. Zhang, S. Ke et al. Hypertension outcomes of adrenalectomy in patients with primary aldosteronism: a systematic review and meta-analysis. BMC Endocr. Disord. 17(1), 61 (2017)

    Article  Google Scholar 

  20. S. Monticone, F. D’Ascenzo, C. Moretti et al. Cardiovascular events and target organ damage in primary aldosteronism compared with essential hypertension: a systematic review and meta-analysis. Lancet Diabetes Endocrinol. 6(1), 41–50 (2018)

    Article  CAS  Google Scholar 

  21. H. Wachtel, I. Cerullo, E.K. Bartlett et al. Long-term blood pressure control in patients undergoing adrenalectomy for primary hyperaldosteronism. Surgery 156(6), 1394–1403 (2014)

    Article  Google Scholar 

  22. L. Pasquier, M. Kirouani, F. Fanget et al. Assessment of the Aldosteronona resolution score as a predictive resolution score of hypertension after adrenalectomy for aldosteronoma in French patients. Langenbecks Arch. Surg. 402(2), 309–314 (2017)

    Article  Google Scholar 

  23. P.J. Worth, N.R. Kunio, I. Siegfried et al. Characteristics predicting clinical improvement and cure following laparoscopic adrenalectomy for primary aldosteronism in a large cohort. Am. J. Surg. 210(4), 702–709 (2015)

    Article  Google Scholar 

  24. X. Zhang, Z. Zhu, T. Xu et al. Factors affecting complete hypertension cure after adrenalectomy for aldosterone-producing adenoma: outcomes in a large series. Urol. Int. 90(4), 430–434 (2013)

    Article  Google Scholar 

  25. T. Utsumi, K. Kawamura, T. Imamoto et al. Assessment of postoperative changes in antihypertensive drug consumption in patients with primary aldosteronism using the defined daily dose. Asian J. Surg. 37(4), 190–4 (2014)

    Article  Google Scholar 

  26. C.Y. Lo, P.C. Tam, A.W. Kung et al. Primary aldosteronism. Results of surgical treatment. Ann. Surg. 224, 125–130 (1996)

    Article  CAS  Google Scholar 

  27. L.M. Brunt, J.F. Moley, G.M. Doherty et al. Outcomes analysis in patients undergoing laparoscopic adrenalectomy for hormonally active adrenal tumors. Surgery 130, 629–634 (2001)

    Article  CAS  Google Scholar 

  28. P. Meria, B.F. Kempf, J.F. Hermieu et al. Laparoscopic management of primary hyperaldosteronism: clinical experience with 212 cases. J. Urol. 169(1), 32–5 (2003)

    Article  Google Scholar 

  29. T.C. Pang, C. Bambach, J.C. Monaghan et al. Outcomes of laparoscopic adrenalectomy for hyperaldosteronism. ANZ J. Surg. 77, 768–773 (2007)

    Article  Google Scholar 

  30. B.K. Goh, Y.H. Tan, S.K. Yip, P.H. Eng et al. Outcome of patients undergoing laparoscopic adrenalectomy for primary hyperaldosteronism. JSLS 8, 320–325 (2004)

    PubMed  PubMed Central  Google Scholar 

  31. M. Murashima, S.O. Trerotola, D.L. Fraker et al. Adrenal venous sampling for primary aldosteronism and clinical outcomes after unilateral adrenalectomy: a single-center experience. J. Clin. Hypertens. 11, 316–323 (2009)

    Article  Google Scholar 

  32. N. Sukor, R.D. Gordon, Y.K. Ku et al. Role of unilateral adrenalectomy in bilateral primary aldosteronism: a 22- year single center experience. J. Clin. Endocrinol. Metab. 94, 2437–2445 (2009)

    Article  CAS  Google Scholar 

  33. R. Zarnegar, W.F. Young Jr, J. Lee et al. The aldosteronoma resolution score: predicting complete resolution of hypertension after adrenalectomy for aldosteronoma. Ann. Surg. 247(3), 511–8 (2008)

    Article  Google Scholar 

  34. R.V. Lloyd, B.R. Douglas, W.F. Young Jr. Endocrine diseases: Atlas of nontumor pathology. First series, Facicle 1. (AFIP, Washington DC), 2002) 218

    Google Scholar 

  35. J. Rosai. Lesions of the adrenal cortex. ed. by Rosai J, Rosai and Ackerman’s surgical pathology, 9th ed Mosby, 1119 (2004)

  36. A.R. Quillo, C.S. Grant, G.B. Thompson et al. Primary aldosteronism: results of adrenalectomy for nonsingle adenoma. J. Am. Coll. Surg. 213(1), 106–113 (2011)

    Article  Google Scholar 

  37. Y.W. Novitsky, K.W. Kercher, M.J. Rosen et al. Clinical outcomes of laparoscopic adrenalectomy for lateralizing nodular hyperplasia. Surgery 138(6), 1009–16 (2005)

    Article  Google Scholar 

  38. J. Hennings, S. Andreasson, J. Botling et al. Long-term effects of surgical correction of adrenal hyperplasia and adenoma causing primary aldosteronism. Langenbecks Arch. Surg. 395(2), 133–7 (2010)

    Article  CAS  Google Scholar 

  39. M.K. Walz, R. Gwosdz, S.L. Levin et al. Retroperitoneoscopic adrenalectomy in Conn’s syndrome caused by adrenal adenomas or nodular hyperplasia. World J. Surg. 32(5), 847–53 (2008)

    Article  Google Scholar 

  40. C. Trésallet, H. Salepçioglu, G. Godiris-Petit et al. Clinical outcome after laparoscopic adrenalectomy for primary hyperaldosteronism: the role of pathology. Surgery 148(1), 129–34 (2010)

    Article  Google Scholar 

  41. M. Iacobone, M. Citton, G. Viel et al. Unilateraladrenal hyperplasia: a novel cause of surgically correctable primary hyperaldosteronism. Surgery 152(6), 1248–55 (2012)

    Article  Google Scholar 

  42. A.B. Weisbrod, R.C. Webb, A. Mathur et al. Adrenal histologic findings show no difference in clinical presentation and outcome in primary hyperaldosteronism. Ann. Surg. Oncol. 20(3), 753–8 (2013)

    Article  Google Scholar 

Download references

Funding

The study was supported by the Ministry of Health of the Czech Republic, grant no. 17-31847A.

Author information

Authors and Affiliations

  1. Department of Urology, University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacky University Olomouc, Olomouc, Czech Republic

    Igor Hartmann, Frantisek Hruska & Marika Nesvadbova

  2. Department of Internal Medicine and Cardiology, University Hospital Ostrava and Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic

    Jan Vaclavik

  3. Faculty of Medicine and Dentistry, Palacky University Olomouc, Olomouc, Czech Republic

    Jan Vaclavik

  4. Department of Internal Medicine I—Cardiology, University Hospital and Faculty of Medicine and Dentistry, Palacky University Olomouc, Olomouc, Czech Republic

    Eva Kocianova

  5. Department of Internal Medicine III, University Hospital and Faculty of Medicine and Dentistry, Palacky University Olomouc, Olomouc, Czech Republic

    Zdenek Frysak

  6. Department of Radiology, University Hospital and Faculty of Medicine and Dentistry, Palacky University, Olomouc, Czech Republic

    Zbynek Tudos & Filip Ctvrtlik

  7. Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic

    Klara Benesova

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Correspondence to Frantisek Hruska.

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Hartmann, I., Hruska, F., Vaclavik, J. et al. Hypertension outcomes of adrenalectomy for unilateral primary aldosteronism. Endocrine 76, 142–150 (2022). https://doi.org/10.1007/s12020-022-02988-y

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