Cardiovascular events and all-cause mortality in surgically or medically treated primary aldosteronism: A Meta-analysis

Jing, Ying; Liao, Kangla; Li, Ruolin; Song, Ying; He, Wenwen; Wang, Kanran; Yang, Jun; Li, Qifu; Hu, Jinbo

doi:10.1177/14703203211003781

Cited by 17 publications

(7 citation statements)

References 31 publications

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“…[1][2][3][4] Unilateral PA (UPA), which is treated by adrenalectomy, and bilateral PA (BPA), which is treated medically, are the 2 major subtypes of PA. Patients with surgically treated PA have better long-term outcomes compared with patients with medically treated PA [5][6][7][8][9][10] ; hence, accurate subtyping is important. The current guidelines recommend adrenal venous sampling (AVS) for subtyping in most patients with PA. [11][12][13] Corticotropin (ACTH) is used during AVS in some centers due to reported benefit of increasing the rates of successful adrenal vein cannulation.…”

Section: Introductionmentioning

confidence: 99%

Corticotropin Stimulation in Adrenal Venous Sampling for Patients With Primary Aldosteronism

Yang,

Du,

Zhang

et al. 2023

JAMA Netw Open

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ImportanceAdrenal venous sampling (AVS) is usually recommended to distinguish between unilateral and bilateral primary aldosteronism (PA) before definitive surgical or medical treatment is offered. Whether a treatment decision based on AVS with or without corticotropin (ACTH) stimulation leads to different biochemical and clinical remission rates in patients with PA remains unclear.ObjectiveTo evaluate whether treatment decisions based on AVS with or without ACTH stimulation lead to different biochemical and clinical remission rates in patients with PA.Design, Setting, and ParticipantsThis randomized clinical trial (RCT) was conducted at a tertiary hospital in China from July 8, 2020, to February 20, 2023, among patients with PA aged 18 to 70 years. Patients were followed up for 12 months after the initiation of treatment. An intention-to-diagnose analysis was conducted.InterventionsPatients were randomly assigned to undergo either ACTH-stimulated or non–ACTH-stimulated AVS.Main Outcomes and MeasuresThe primary end point was the proportion of patients with complete biochemical remission after 12 months of follow-up. Secondary outcomes included the proportion of patients who achieved complete clinical remission after 12 months of follow-up, dosages of antihypertensive agents, rate of successful bilateral AVS, and adverse events.ResultsOf 228 patients with PA, 115 were randomized to the non–ACTH-stimulated group (median age, 50.0 years [IQR, 41.0-57.0 years]; 70 males [60.9%]) and 113 to the ACTH-stimulated group (median age, 50.0 years [IQR, 43.5-56.5 years]; 63 males [55.8%]). A total of 68 patients (59.1%) underwent adrenalectomy in the non-ACTH group and 65 (57.5%) in the ACTH group. There was no significant difference in the proportion of patients with complete biochemical remission who were managed on the basis of AVS with vs without ACTH stimulation (with: 56 of 113 [49.6%]; without: 59 of 115 [51.3%]; P = .79). There also was no significant difference in the proportion of patients who achieved complete clinical remission between the non-ACTH and ACTH groups (26 of 115 [22.6%] and 31 of 113 [27.4%], respectively; P = .40). The intensity of therapy with antihypertensives, successful catheterization of bilateral adrenal veins, and incidence of adverse events did not significantly differ between the non-ACTH and ACTH groups.Conclusions and RelevanceIn this RCT, treatment of PA on the basis of non–ACTH-stimulated or ACTH-stimulated AVS did not lead to significant differences in clinical outcomes for the patients. These results suggest that ACTH stimulation during AVS may not have clinical benefit, at least in the Chinese population.Trial RegistrationClinicalTrials.gov Identifier: NCT04461535

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Section: Introductionmentioning

confidence: 99%

Corticotropin Stimulation in Adrenal Venous Sampling for Patients With Primary Aldosteronism

Yang,

Du,

Zhang

et al. 2023

JAMA Netw Open

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“…In line with the metabolomic traits, the MI in patients with PA, such as citrulline/ornithine and ornithine/arginine, which are associated with increased cardiovascular risk and phenotypic features of metabolic syndrome, were mainly associated with cortisol, cortisone, corticosterone, and DHEA in our regression analysis. Based on these observations, it can be speculated that the poorer cardiovascular outcomes in patients with PA treated pharmacologically by inhibiting aldosterone activity compared to surgery ( 52 ) might be related to the unopposed activity of the other adrenal steroids.…”

Section: Discussionmentioning

confidence: 99%

Association of adrenal steroids with metabolomic profiles in patients with primary and endocrine hypertension

Knuchel,

Erlic,

Gruber

et al. 2024

Front. Endocrinol.

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IntroductionEndocrine hypertension (EHT) due to pheochromocytoma/paraganglioma (PPGL), Cushing’s syndrome (CS), or primary aldosteronism (PA) is linked to a variety of metabolic alterations and comorbidities. Accordingly, patients with EHT and primary hypertension (PHT) are characterized by distinct metabolic profiles. However, it remains unclear whether the metabolomic differences relate solely to the disease-defining hormonal parameters. Therefore, our objective was to study the association of disease defining hormonal excess and concomitant adrenal steroids with metabolomic alterations in patients with EHT.MethodsRetrospective European multicenter study of 263 patients (mean age 49 years, 50% females; 58 PHT, 69 PPGL, 37 CS, 99 PA) in whom targeted metabolomic and adrenal steroid profiling was available. The association of 13 adrenal steroids with differences in 79 metabolites between PPGL, CS, PA and PHT was examined after correction for age, sex, BMI, and presence of diabetes mellitus.ResultsAfter adjustment for BMI and diabetes mellitus significant association between adrenal steroids and metabolites – 18 in PPGL, 15 in CS, and 23 in PA – were revealed. In PPGL, the majority of metabolite associations were linked to catecholamine excess, whereas in PA, only one metabolite was associated with aldosterone. In contrast, cortisone (16 metabolites), cortisol (6 metabolites), and DHEA (8 metabolites) had the highest number of associated metabolites in PA. In CS, 18-hydroxycortisol significantly influenced 5 metabolites, cortisol affected 4, and cortisone, 11-deoxycortisol, and DHEA each were linked to 3 metabolites.DiscussionsOur study indicates cortisol, cortisone, and catecholamine excess are significantly associated with metabolomic variances in EHT versus PHT patients. Notably, catecholamine excess is key to PPGL’s metabolomic changes, whereas in PA, other non-defining adrenal steroids mainly account for metabolomic differences. In CS, cortisol, alongside other non-defining adrenal hormones, contributes to these differences, suggesting that metabolic disorders and cardiovascular morbidity in these conditions could also be affected by various adrenal steroids.

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“…In contrast, surgical adrenalectomy may reduce aldosterone levels to normal in unilateral hyper-aldosterone-producing adenoma. Adrenalectomy can cure hypertension among 30-60% of patients and completely correct hypokalemia, resulting in a decreased incidence of atrial fibrillation and cardiovascular-related mortality in PA patients [24,25].…”

Section: Role Of Surgical Management In Primary Hyperaldosteronismmentioning

confidence: 99%

Primary Hyperaldosteronism: The Role of the General Surgeons in Diagnosis and Treatment

Tullavardhana¹

2024

Adrenal Glands - The Current Stage and New Perspectives of Diseases and Treatment

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Primary hyperaldosteronism (PA) is the cause of endocrine hypertension, which commonly occurs in young patients with uncontrolled hypertension that leads to worsening cardiovascular-related mortality. Patients suspected of developing PA should have their plasma aldosterone concentration and plasma renin activity (PRA) assessed for screening purposes. After verifying the diagnosis of PA, adrenal venous sample (AVS) is the gold standard diagnostic technique for differentiating unilateral from bilateral disease. Since adrenalectomy may benefit patients with unilateral disease, laparoscopic adrenalectomy, a minimally invasive surgical approach that provides better postoperative outcomes than open surgery, has become the standard treatment for unilateral PA. Laparoscopic adrenalectomy resulted in a 53% cure rate of hypertension after surgery, as well as all patients had improved hypertension control, including the remission of hypokalemia. The conventional laparoscopic adrenalectomy approaches are transperitoneal and retroperitoneal, with similar postoperative outcomes. However, for general surgeons with limited laparoscopic adrenalectomy experience, the transperitoneal technique may offer an advantage over the retroperitoneal approach in terms of faster learning curve time, better surgical anatomy view, and the ability to resect adrenal tumors larger than 5 cm. This chapter focuses on the diagnosis and treatment of PA from the general surgeon’s perspective.

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Cardiovascular events and all-cause mortality in surgically or medically treated primary aldosteronism: A Meta-analysis

Cited by 17 publications

References 31 publications

Corticotropin Stimulation in Adrenal Venous Sampling for Patients With Primary Aldosteronism

Corticotropin Stimulation in Adrenal Venous Sampling for Patients With Primary Aldosteronism

Association of adrenal steroids with metabolomic profiles in patients with primary and endocrine hypertension

Primary Hyperaldosteronism: The Role of the General Surgeons in Diagnosis and Treatment

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