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

Takuyuki Katabami, Hisashi Fukuda, Hidekazu Tsukiyama, Yasushi Tanaka, Yoshiyu Takeda, Isao Kurihara, Hiroshi Ito, Mika Tsuiki, Takamasa Ichijo, Norio Wada, Yui Shibayama, Takanobu Yoshimoto, Yoshihiro Ogawa, Junji Kawashima, Masakatsu Sone, Nobuya Inagaki, Katsutoshi Takahashi, Megumi Fujita, Minemori Watanabe, Yuichi MatsudaHiroki Kobayashi, Hirotaka Shibata, Kohei Kamemura, Michio Otsuki, Yuichi Fujii, Koichi Yamamoto, Atsushi Ogo, Toshihiko Yanase, Tomoko Suzuki, Mitsuhide Naruse

Research output: Contribution to journalArticle

7 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

Keywords

  • adrenalectomy
  • medical treatment
  • unilateral primary aldosteronism

ASJC Scopus subject areas

  • Internal Medicine
  • Physiology
  • Cardiology and Cardiovascular Medicine

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    Katabami, T., Fukuda, H., Tsukiyama, H., Tanaka, Y., Takeda, Y., Kurihara, I., Ito, H., Tsuiki, M., Ichijo, T., Wada, N., Shibayama, Y., Yoshimoto, T., Ogawa, Y., Kawashima, J., Sone, M., Inagaki, N., Takahashi, K., Fujita, M., Watanabe, M., ... Naruse, M. (2019). Clinical and biochemical outcomes after adrenalectomy and medical treatment in patients with unilateral primary aldosteronism. Journal of hypertension, 37(7), 1513-1520. https://doi.org/10.1097/HJH.0000000000002070