Predictive factors of clinical success after adrenalectomy in primary aldosteronism: A systematic review and meta-analysis

Manosroi, Worapaka; Atthakomol, Pichitchai; Phinyo, Phichayut; Inthaphan, Piti

doi:10.3389/fendo.2022.925591

Cited by 6 publications

(4 citation statements)

References 58 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Patients with adrenal adenomas were the likeliest to be cured in our study. Wang et al (18) found the same result as we did, Celen et al (16) found that persistent hypertension after adrenalectomy was only favored by micronodular hyperplasia, while Proye et al (26) did not found a statistically significant association between pathologic findings and hypertension cure. These results should prompt us to warn patients, in whom the diagnoses of hyperplasia has been confirmed by examination of the operative specimen, of the possibility of persistent hypertension and that complete resolution of hypertension is more unlikely.…”

Section: Discussionsupporting

confidence: 82%

“…Indeed, many studies have suggested that patients are more likely to become normotensive after adrenalectomy if they are aged 50 years or younger and have had hypertension for less than 5 years at the time of surgery ( 12 , 14 , 17 , 18 ). It has been suggested that long-lasting hypertension (despite surgical correction of hormonal abnormalities) causes irreversible vascular damages, which is the main reason for explaining why prolonged hypertension is a risk factor for surgical outcome ( 19 ).…”

Section: Discussionmentioning

confidence: 99%

“…Relevant and reproducible definitions of the clinical and biochemical outcome of surgical treatment have been made possible by the development of the PASO criteria (16). Unfortunately, the assessment of biochemical outcomes was hampered by missing data and may be partly explained by the lack of consistent reporting criteria during the study period , with the proposed PASO criteria being published in 2017 (12).…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Predictors of successful outcome after adrenalectomy for unilateral primary aldosteronism

Saadi,

Bedoui,

Zaghbib

et al. 2023

Front. Endocrinol.

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionsupporting

confidence: 82%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Predictors of successful outcome after adrenalectomy for unilateral primary aldosteronism

Saadi,

Bedoui,

Zaghbib

et al. 2023

Front. Endocrinol.

View full text Add to dashboard Cite

show abstract

“…23 Furthermore, a multicenter study showed that young patients were more likely to benefit from surgical treatment. 24,25 This favorable overall outcome in young patients with PA probably reflects the beneficial effect of early detection of PA and early administration of disease-specific treatment for the disease. The strong association between cardiovascular comorbidities at baseline and mortality also supports the importance of early detection and treatment of PA.…”

Section: Discussionmentioning

confidence: 99%

Mortality in Patients With Primary Aldosteronism: A Swedish Nationwide Study

Gkaniatsa,

Zverkova Sandström,

Rosengren

et al. 2023

Hypertension

View full text Add to dashboard Cite

BACKGROUND: Primary aldosteronism (PA) is associated with increased mortality. The extent to which this phenomenon is affected by gender, age, comorbidities at diagnosis, and different treatment modalities is largely unknown. The objective was to determine all-cause and cause-specific mortality in a population-based cohort of patients with PA and the impact of age at diagnosis, sex, comorbidities, and treatment modalities. METHODS: We used national registers to identify patients diagnosed with PA between 1997 and 2019 (n=2419) and controls (n=24 187) from the general population, matched for sex, age, and county of residence. We obtained mortality data from the Cause-of-Death Register. We used Cox regression models, adjusted for socioeconomic factors and diabetes, to estimate adjusted hazard ratios (HRs [95% CI]). RESULTS: Overall, 346 (14.3%) patients with PA and 2736 (11.3%) controls died during a median follow-up time of 8.1 years. PA was associated with increased risk from all-cause mortality (HR, 1.23 [95% CI, 1.10–1.38]), death from cardiovascular disease (HR, 1.57 [95% CI, 1.30–1.89]), and stroke (HR, 1.85 [95% CI, 1.16–2.93]). Patients with cardiovascular disease at diagnosis (HR, 1.53 [1.26–1.85]), age >56 years (HR, 1.28 [95% CI, 1.13–1.45]), patients treated with a low dose of a mineralocorticoid receptor antagonist (HR, 1.30 [95% CI, 1.02–1.66]), and untreated patients (HR, 2.51 [95% CI, 1.72–3.67]) had excess mortality. CONCLUSIONS: Mortality, mainly due to cardiovascular disease, is increased in patients with PA compared with controls from the general population, particularly in patients aged >56 years, patients with preexisting cardiovascular comorbidities, and patients receiving low dose of a mineralocorticoid receptor antagonist.

show abstract

Predicting the resolution of hypertension following adrenalectomy in primary aldosteronism: Controversies and unresolved issues a narrative review

Marzano

2024

Langenbecks Arch Surg

View full text Add to dashboard Cite

Predictive factors of clinical success after adrenalectomy in primary aldosteronism: A systematic review and meta-analysis

Cited by 6 publications

References 58 publications

Predictors of successful outcome after adrenalectomy for unilateral primary aldosteronism

Predictors of successful outcome after adrenalectomy for unilateral primary aldosteronism

Mortality in Patients With Primary Aldosteronism: A Swedish Nationwide Study

Predicting the resolution of hypertension following adrenalectomy in primary aldosteronism: Controversies and unresolved issues a narrative review

Contact Info

Product

Resources

About