Predictors of successful outcome after adrenalectomy for unilateral primary aldosteronism

Frontiers in Endocrinology

Endocrinology

Ibtissem Ben Nacef¹  Karima Khiari¹  Hamza Boussaffa²  Marouene Chakroun²  Ahmed Saadi²  Selim Zaghbib²  Riadh Ben Slama²  Seif Mokaddem²  Haroun Ayed²  Amine Derouiche²  Mohamed Ali Bedoui² 

[1] Department of Endocrinology, University of Medicine of Tunis, Charles Nicolle Hospital, Tunis, Tunisia;Department of Urology, University of Medicine of Tunis, Charles Nicolle Hospital, Tunis, Tunisia;

关键词: primary aldosteronism;    adrenalectomy;    hypertension;    resistant hypertension;    prediction systems;   

DOI  :  10.3389/fendo.2023.1205988

 received in 2023-04-14, accepted in 2023-07-18,  发布年份 2023

来源: Frontiers

【 摘 要 】

IntroductionUnilateral primary aldosteronism (UPA) is the most frequent surgically curable form of endocrine hypertension. Adrenalectomy is the cornerstone of treatment for UPA, but outcomes after surgery are variable. The cause of resistant hypertension after surgery is still a matter of debate. Our aim was to investigate cure rates after surgery and to evaluate preoperative factors that might influence the surgical outcome.MethodsBetween 2000 and 2021, the charts of 71 Tunisian patients who underwent laparoscopic adrenalectomy for UPA were retrospectively reviewed. Preoperative medical records were collected and follow-up data (1-158 months) were registered. Antihypertensive medication doses were calculated using defined daily doses (DDD) and postoperative outcomes were assessed using the Primary Aldosteronism Surgical Outcome (PASO) criterion.ResultsOf 91 enrolled patients, 71 (59% women, mean age 46 years, median length of follow-up 21 months) were suitable for evaluation. Thirty-four patients (48%) had complete clinical success according to the PASO criteria. The most relevant factors associated with complete clinical success on univariate analysis were: absence of diabetes (p= 0.007), low body mass index (BMI) (p= 0.001), lower preoperative DDD (p= 0.01), preoperatively controlled blood pressure (p= 0.024), higher plasma aldosterone to renin ratio (ARR) (p= 0.001), adenoma subtyping (p <0.001) and aldosteronoma resolution score (ARS) (p= 0.002). Multivariate regression analysis showed that the major predictors of complete clinical success were absence of diabetes (OR: 5.205), a BMI < 30 (OR: 4.930), a plasma ARR > 332 (OR: 4.554) and an ARS ≥ 3 (OR: 2.056).ConclusionComplete and partial clinical response rates were achieved in respectively 48 and 43% of cases. The main predictors of complete resolution of hypertension were absence of diabetes, low BMI, high plasma ARR and high ARS. Taking these factors into account may help identify patients at risk of persistent postoperative hypertension who may require long-term surveillance and medication.

【 授权许可】

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Copyright © 2023 Saadi, Bedoui, Zaghbib, Boussaffa, Mokaddem, Nacef, Ayed, Derouiche, Khiari, Chakroun and Ben Slama