Assessment of biochemical outcomes in patients with primary aldosteronism after adrenalectomy based on CT scan diagnosis of unilateral adenoma without adrenal vein sampling

Abstract

PurposeThe purpose of this study was to assess the surgical outcomes of patients with primary aldosteronism when surgery was based only on CT finding of unilateral adenoma without adrenal vein sampling (AVS).MethodsThis is a retrospective review of the records of patients who had undergone retroperitoneal laparoscopic adrenalectomy for primary aldosteronism based on CT scan finding of unilateral adenoma and had a follow-up of at least 6–12 months from January 2012 to December 2020 in a single center; decision for adrenalectomy was based on CT scan, and AVS was not used. The clinical and biochemical outcomes were accessed using the standardized primary aldosteronism surgical outcome (PASO) criteria. Patient’s demographics and preoperative factors were analyzed to assess for independent predictor of surgical success.ResultsAccording to the PASO criteria, 172 patients finally enrolled in the training dataset, and 20 patients enrolled in the validation dataset. In the training dataset, complete clinical success was achieved in 71 patients (41.3%), partial success in 87 (50.6%), and absent success in 14 (8.1%). Biochemical outcomes showed that 151 patients (87.8%) were completely cured, 14 patients (8.1%) got a partial biochemical success, and an absent biochemical success was found in seven patients (4.1%). Multivariate logistic regression analysis showed that age, body mass index (BMI), tumor size, mean arterial pressure (MAP), and serum potassium were the most independent factors for incomplete biochemical success. Based on the results of statistical analysis, our study constructed a nomogram prognostic evaluation model for patients after unilateral primary aldosterone surgery.ConclusionsLaparoscopic adrenalectomy for patients with primary aldosteronism base on CT scan finding of a unilateral adenoma without AVS had a high rate of complete biochemical cure at 12 months. Risk factors for incomplete biochemical success include age, BMI, tumor size, MAP, and serum potassium. Our study constructed a nomogram prognostic evaluation model for patients after unilateral primary aldosterone surgery. The nomogram accurately and reliably predicted the incomplete biochemical success.

Prolactinoma asociada a hiperaldosteronismo primario: ¿existe una relación entre ambas entidades?

“…Una vez el AP esté confirmado, el algoritmo de manejo propone la realización de cateterismo bilateral de venas adrenales (AVS por sus siglas en inglés) para aquellos sujetos mayores de 35 años en los que la prevalencia que hiperplasia adrenal bilateral suele ser mayor (21), no obstante, este procedimiento es costoso, requiere considerables habilidades técnicas y no está disponible en todos los centros (24).…”

“…Como previamente se mencionó, en el caso de nuestra paciente no se logró remisión clínica de la hipertensión arterial, pero sí se logró disminuir la carga de medicación antihipertensiva. Algunas de las características clínicas que se han relacionado con remisión bioquímica incompleta posterior a la adrenalectomía sin AVS son: mayor edad (> 50 años), mayor BMI (> 28,5) y cifras de presión arterial, tamaño del tumor (< 10 mm) y un valor normal de potasio (24). Nuestra paciente tenía un pobre control de cifras tensionales con uso concomitante de más de dos antihipertensivos, además de historia de hipertensión arterial esencial en familiar de primer grado (padre), lo que pudo haber socavado la posibilidad de curación.…”