Clinical and biochemical outcomes after adrenalectomy and medical treatment in patients with unilateral primary aldosteronism

JPAS/JRAS Study Group

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

OBJECTIVES: Current clinical guidelines of primary aldosteronism recommend adrenalectomy (AdX) for unilateral primary aldosteronism based on the studies showing the potential superiority of AdX over the medical treatment. However, since most medically treated cases consisted of bilateral primary aldosteronism and all surgically treated cases consisted of unilateral primary aldosteronism, the different subtype of primary aldosteronism could be a bias for their effects. This study compared the effects of AdX and medical therapy in patients with unilateral primary aldosteronism confirmed by adrenal vein sampling. METHODS: Of the 339 patients with unilateral primary aldosteronism in the Japan Primary Pldosteronism Study data base, unilateral AdX and treatment with mineral corticoid receptor antagonists (MRAs) was done in 276 patients (AdX group) and in 63 patients (MRAs group), respectively. The effects were compared by the clinical (improvement of blood pressure) and biochemical outcomes (improvement of hypokalemia). RESULTS: At baseline, use of potassium replacement, plasma aldosterone concentration, aldosterone-to-renin ratio, estimated glomerular filtration rate, and prevalence of adrenal mass on imaging were higher in the AdX group than in the MRAs group. At 6 months after commencement of specific treatment for primary aldosteronism, clinical outcome and biochemical outcome in the AdX group were superior than those in the MRAs group. The difference of the outcome between the two groups were the case even after adjusting for the different clinical backgrounds in the two groups before the specific treatment. CONCLUSION: Our study provides evidence that AdX is the first choice of treatment in the patients with unilateral primary aldosteronism in terms of clinical and biochemical outcome.

Original languageEnglish
Pages (from-to)1513-1520
Number of pages8
JournalJournal of hypertension
Volume37
Issue number7
DOIs
Publication statusPublished - 2019 Jul 1

Fingerprint

Hyperaldosteronism
Adrenalectomy
Minerals
Adrenal Cortex Hormones
Therapeutics
Aldosterone
Hypokalemia
Glomerular Filtration Rate
Renin
Veins
Potassium
Japan
Databases
Guidelines
Blood Pressure

ASJC Scopus subject areas

  • Internal Medicine
  • Physiology
  • Cardiology and Cardiovascular Medicine

Cite this

Clinical and biochemical outcomes after adrenalectomy and medical treatment in patients with unilateral primary aldosteronism. / JPAS/JRAS Study Group.

In: Journal of hypertension, Vol. 37, No. 7, 01.07.2019, p. 1513-1520.

Research output: Contribution to journalArticle

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title = "Clinical and biochemical outcomes after adrenalectomy and medical treatment in patients with unilateral primary aldosteronism",
abstract = "OBJECTIVES: Current clinical guidelines of primary aldosteronism recommend adrenalectomy (AdX) for unilateral primary aldosteronism based on the studies showing the potential superiority of AdX over the medical treatment. However, since most medically treated cases consisted of bilateral primary aldosteronism and all surgically treated cases consisted of unilateral primary aldosteronism, the different subtype of primary aldosteronism could be a bias for their effects. This study compared the effects of AdX and medical therapy in patients with unilateral primary aldosteronism confirmed by adrenal vein sampling. METHODS: Of the 339 patients with unilateral primary aldosteronism in the Japan Primary Pldosteronism Study data base, unilateral AdX and treatment with mineral corticoid receptor antagonists (MRAs) was done in 276 patients (AdX group) and in 63 patients (MRAs group), respectively. The effects were compared by the clinical (improvement of blood pressure) and biochemical outcomes (improvement of hypokalemia). RESULTS: At baseline, use of potassium replacement, plasma aldosterone concentration, aldosterone-to-renin ratio, estimated glomerular filtration rate, and prevalence of adrenal mass on imaging were higher in the AdX group than in the MRAs group. At 6 months after commencement of specific treatment for primary aldosteronism, clinical outcome and biochemical outcome in the AdX group were superior than those in the MRAs group. The difference of the outcome between the two groups were the case even after adjusting for the different clinical backgrounds in the two groups before the specific treatment. CONCLUSION: Our study provides evidence that AdX is the first choice of treatment in the patients with unilateral primary aldosteronism in terms of clinical and biochemical outcome.",
author = "{JPAS/JRAS Study Group} and Takuyuki Katabami and Hisashi Fukuda and Hidekazu Tsukiyama and Yasushi Tanaka and Yoshiyu Takeda and Isao Kurihara and Hiroshi Ito and Mika Tsuiki and Takamasa Ichijo and Norio Wada and Yui Shibayama and Takanobu Yoshimoto and Yoshihiro Ogawa and Junji Kawashima and Masakatsu Sone and Nobuya Inagaki and Katsutoshi Takahashi and Megumi Fujita and Minemori Watanabe and Yuichi Matsuda and Hiroki Kobayashi and Hirotaka Shibata and Kohei Kamemura and Michio Otsuki and Yuichi Fujii and Koichi Yamamoto and Atsushi Ogo and Toshihiko Yanase and Tomoko Suzuki and Mitsuhide Naruse",
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T1 - Clinical and biochemical outcomes after adrenalectomy and medical treatment in patients with unilateral primary aldosteronism

AU - JPAS/JRAS Study Group

AU - Katabami, Takuyuki

AU - Fukuda, Hisashi

AU - Tsukiyama, Hidekazu

AU - Tanaka, Yasushi

AU - Takeda, Yoshiyu

AU - Kurihara, Isao

AU - Ito, Hiroshi

AU - Tsuiki, Mika

AU - Ichijo, Takamasa

AU - Wada, Norio

AU - Shibayama, Yui

AU - Yoshimoto, Takanobu

AU - Ogawa, Yoshihiro

AU - Kawashima, Junji

AU - Sone, Masakatsu

AU - Inagaki, Nobuya

AU - Takahashi, Katsutoshi

AU - Fujita, Megumi

AU - Watanabe, Minemori

AU - Matsuda, Yuichi

AU - Kobayashi, Hiroki

AU - Shibata, Hirotaka

AU - Kamemura, Kohei

AU - Otsuki, Michio

AU - Fujii, Yuichi

AU - Yamamoto, Koichi

AU - Ogo, Atsushi

AU - Yanase, Toshihiko

AU - Suzuki, Tomoko

AU - Naruse, Mitsuhide

PY - 2019/7/1

Y1 - 2019/7/1

N2 - OBJECTIVES: Current clinical guidelines of primary aldosteronism recommend adrenalectomy (AdX) for unilateral primary aldosteronism based on the studies showing the potential superiority of AdX over the medical treatment. However, since most medically treated cases consisted of bilateral primary aldosteronism and all surgically treated cases consisted of unilateral primary aldosteronism, the different subtype of primary aldosteronism could be a bias for their effects. This study compared the effects of AdX and medical therapy in patients with unilateral primary aldosteronism confirmed by adrenal vein sampling. METHODS: Of the 339 patients with unilateral primary aldosteronism in the Japan Primary Pldosteronism Study data base, unilateral AdX and treatment with mineral corticoid receptor antagonists (MRAs) was done in 276 patients (AdX group) and in 63 patients (MRAs group), respectively. The effects were compared by the clinical (improvement of blood pressure) and biochemical outcomes (improvement of hypokalemia). RESULTS: At baseline, use of potassium replacement, plasma aldosterone concentration, aldosterone-to-renin ratio, estimated glomerular filtration rate, and prevalence of adrenal mass on imaging were higher in the AdX group than in the MRAs group. At 6 months after commencement of specific treatment for primary aldosteronism, clinical outcome and biochemical outcome in the AdX group were superior than those in the MRAs group. The difference of the outcome between the two groups were the case even after adjusting for the different clinical backgrounds in the two groups before the specific treatment. CONCLUSION: Our study provides evidence that AdX is the first choice of treatment in the patients with unilateral primary aldosteronism in terms of clinical and biochemical outcome.

AB - OBJECTIVES: Current clinical guidelines of primary aldosteronism recommend adrenalectomy (AdX) for unilateral primary aldosteronism based on the studies showing the potential superiority of AdX over the medical treatment. However, since most medically treated cases consisted of bilateral primary aldosteronism and all surgically treated cases consisted of unilateral primary aldosteronism, the different subtype of primary aldosteronism could be a bias for their effects. This study compared the effects of AdX and medical therapy in patients with unilateral primary aldosteronism confirmed by adrenal vein sampling. METHODS: Of the 339 patients with unilateral primary aldosteronism in the Japan Primary Pldosteronism Study data base, unilateral AdX and treatment with mineral corticoid receptor antagonists (MRAs) was done in 276 patients (AdX group) and in 63 patients (MRAs group), respectively. The effects were compared by the clinical (improvement of blood pressure) and biochemical outcomes (improvement of hypokalemia). RESULTS: At baseline, use of potassium replacement, plasma aldosterone concentration, aldosterone-to-renin ratio, estimated glomerular filtration rate, and prevalence of adrenal mass on imaging were higher in the AdX group than in the MRAs group. At 6 months after commencement of specific treatment for primary aldosteronism, clinical outcome and biochemical outcome in the AdX group were superior than those in the MRAs group. The difference of the outcome between the two groups were the case even after adjusting for the different clinical backgrounds in the two groups before the specific treatment. CONCLUSION: Our study provides evidence that AdX is the first choice of treatment in the patients with unilateral primary aldosteronism in terms of clinical and biochemical outcome.

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DO - 10.1097/HJH.0000000000002070

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SP - 1513

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JO - Journal of Hypertension

JF - Journal of Hypertension

SN - 0263-6352

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