Clinical characteristics and postoperative outcomes of primary aldosteronism in the elderly

Masao Takeda, Koichi Yamamoto, Hiroshi Akasaka, Hiromi Rakugi, Mitsuhide Naruse, Yoshiyu Takeda, Isao Kurihara, Hiroshi Itoh, Hironobu Umakoshi, Mika Tsuiki, Takamasa Ichijo, Takuyuki Katabami, Norio Wada, Yui Shibayama, Takanobu Yoshimoto, Yoshihiro Ogawa, Junji Kawashima, Masakatsu Sone, Nobuya Inagaki, Katsutoshi TakahashiMegumi Fujita, Minemori Watanabe, Yuichi Matsuda, Hiroki Kobayashi, Hirotaka Shibata, Kohei Kamemura, Michio Otsuki, Yuichi Fujii, Atsushi Ogo, Shintaro Okamura, Shozo Miyauchi, Toshihiko Yanase, Tomoko Suzuki, Takashi Kawamura

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Context: Primary aldosteronism (PA) in the elderly has increased in importance in association with population aging. Objective: To investigate the characteristics and outcomes of elderly patients with PA undergoing adrenalectomy. Patients and Methods: Using a database of patients with PA who underwent adrenal venous sampling (AVS),wecompared elderly patients (65 years old)with nonelderly patients (,65 years old) in terms of characteristics, subtype classification in ACTH-stimulated AVS, and outcomes after adrenalectomy. Results: The elderly group had a higher prevalence of comorbidities than the nonelderly group. The proportion of the unilateral subtype [defined as a lateralization index (LI) .4] was comparable between the age groups. In patients who received adrenalectomy, biochemical cure was comparable between the groups, whereas persistent hypertension was more common in the elderly group. The prevalences of hyperkalemia and renal impairment (chronic kidney disease stage 3b or higher) were higher in the elderly group. Multiple regression analysis showed that the duration of hypertension predicted persistent hypertension and hyperkalemia and that preoperative estimated glomerular filtration rate predicted renal impairment in the elderly group. LI .4 in AVS was an independent predictor of biochemical cure after adrenalectomy in the elderly group but not in the nonelderly group. Age was negatively associated with biochemical cure in patients with LI #4. Conclusion: Adrenalectomy contributes to biochemical improvement in elderly patients if determined in accordance with AVS. The treatment strategy should be determined considering the high postoperative incidence of persistent hypertension and hyperkalemia in elderly patients with a long history of hypertension or renal impairment in those with reduced renal function.

Original languageEnglish
Pages (from-to)3620-3629
Number of pages10
JournalJournal of Clinical Endocrinology and Metabolism
Volume103
Issue number10
DOIs
Publication statusPublished - 2018 Oct 1

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Hyperaldosteronism
Sampling
Adrenalectomy
Hyperkalemia
Hypertension
Regression analysis
Adrenocorticotropic Hormone
Kidney
Aging of materials
Renal Hypertension
Glomerular Filtration Rate
Chronic Renal Insufficiency
Comorbidity
Age Groups
Regression Analysis
Databases

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism
  • Biochemistry
  • Endocrinology
  • Clinical Biochemistry
  • Biochemistry, medical

Cite this

Takeda, M., Yamamoto, K., Akasaka, H., Rakugi, H., Naruse, M., Takeda, Y., ... Kawamura, T. (2018). Clinical characteristics and postoperative outcomes of primary aldosteronism in the elderly. Journal of Clinical Endocrinology and Metabolism, 103(10), 3620-3629. https://doi.org/10.1210/jc.2018-00059

Clinical characteristics and postoperative outcomes of primary aldosteronism in the elderly. / Takeda, Masao; Yamamoto, Koichi; Akasaka, Hiroshi; Rakugi, Hiromi; Naruse, Mitsuhide; Takeda, Yoshiyu; Kurihara, Isao; Itoh, Hiroshi; Umakoshi, Hironobu; Tsuiki, Mika; Ichijo, Takamasa; Katabami, Takuyuki; Wada, Norio; Shibayama, Yui; Yoshimoto, Takanobu; Ogawa, Yoshihiro; Kawashima, Junji; Sone, Masakatsu; Inagaki, Nobuya; Takahashi, Katsutoshi; Fujita, Megumi; Watanabe, Minemori; Matsuda, Yuichi; Kobayashi, Hiroki; Shibata, Hirotaka; Kamemura, Kohei; Otsuki, Michio; Fujii, Yuichi; Ogo, Atsushi; Okamura, Shintaro; Miyauchi, Shozo; Yanase, Toshihiko; Suzuki, Tomoko; Kawamura, Takashi.

In: Journal of Clinical Endocrinology and Metabolism, Vol. 103, No. 10, 01.10.2018, p. 3620-3629.

Research output: Contribution to journalArticle

Takeda, M, Yamamoto, K, Akasaka, H, Rakugi, H, Naruse, M, Takeda, Y, Kurihara, I, Itoh, H, Umakoshi, H, Tsuiki, M, Ichijo, T, Katabami, T, Wada, N, Shibayama, Y, Yoshimoto, T, Ogawa, Y, Kawashima, J, Sone, M, Inagaki, N, Takahashi, K, Fujita, M, Watanabe, M, Matsuda, Y, Kobayashi, H, Shibata, H, Kamemura, K, Otsuki, M, Fujii, Y, Ogo, A, Okamura, S, Miyauchi, S, Yanase, T, Suzuki, T & Kawamura, T 2018, 'Clinical characteristics and postoperative outcomes of primary aldosteronism in the elderly', Journal of Clinical Endocrinology and Metabolism, vol. 103, no. 10, pp. 3620-3629. https://doi.org/10.1210/jc.2018-00059
Takeda, Masao ; Yamamoto, Koichi ; Akasaka, Hiroshi ; Rakugi, Hiromi ; Naruse, Mitsuhide ; Takeda, Yoshiyu ; Kurihara, Isao ; Itoh, Hiroshi ; Umakoshi, Hironobu ; Tsuiki, Mika ; Ichijo, Takamasa ; Katabami, Takuyuki ; Wada, Norio ; Shibayama, Yui ; Yoshimoto, Takanobu ; Ogawa, Yoshihiro ; Kawashima, Junji ; Sone, Masakatsu ; Inagaki, Nobuya ; Takahashi, Katsutoshi ; Fujita, Megumi ; Watanabe, Minemori ; Matsuda, Yuichi ; Kobayashi, Hiroki ; Shibata, Hirotaka ; Kamemura, Kohei ; Otsuki, Michio ; Fujii, Yuichi ; Ogo, Atsushi ; Okamura, Shintaro ; Miyauchi, Shozo ; Yanase, Toshihiko ; Suzuki, Tomoko ; Kawamura, Takashi. / Clinical characteristics and postoperative outcomes of primary aldosteronism in the elderly. In: Journal of Clinical Endocrinology and Metabolism. 2018 ; Vol. 103, No. 10. pp. 3620-3629.
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abstract = "Context: Primary aldosteronism (PA) in the elderly has increased in importance in association with population aging. Objective: To investigate the characteristics and outcomes of elderly patients with PA undergoing adrenalectomy. Patients and Methods: Using a database of patients with PA who underwent adrenal venous sampling (AVS),wecompared elderly patients (65 years old)with nonelderly patients (,65 years old) in terms of characteristics, subtype classification in ACTH-stimulated AVS, and outcomes after adrenalectomy. Results: The elderly group had a higher prevalence of comorbidities than the nonelderly group. The proportion of the unilateral subtype [defined as a lateralization index (LI) .4] was comparable between the age groups. In patients who received adrenalectomy, biochemical cure was comparable between the groups, whereas persistent hypertension was more common in the elderly group. The prevalences of hyperkalemia and renal impairment (chronic kidney disease stage 3b or higher) were higher in the elderly group. Multiple regression analysis showed that the duration of hypertension predicted persistent hypertension and hyperkalemia and that preoperative estimated glomerular filtration rate predicted renal impairment in the elderly group. LI .4 in AVS was an independent predictor of biochemical cure after adrenalectomy in the elderly group but not in the nonelderly group. Age was negatively associated with biochemical cure in patients with LI #4. Conclusion: Adrenalectomy contributes to biochemical improvement in elderly patients if determined in accordance with AVS. The treatment strategy should be determined considering the high postoperative incidence of persistent hypertension and hyperkalemia in elderly patients with a long history of hypertension or renal impairment in those with reduced renal function.",
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T1 - Clinical characteristics and postoperative outcomes of primary aldosteronism in the elderly

AU - Takeda, Masao

AU - Yamamoto, Koichi

AU - Akasaka, Hiroshi

AU - Rakugi, Hiromi

AU - Naruse, Mitsuhide

AU - Takeda, Yoshiyu

AU - Kurihara, Isao

AU - Itoh, Hiroshi

AU - Umakoshi, Hironobu

AU - Tsuiki, Mika

AU - Ichijo, Takamasa

AU - Katabami, Takuyuki

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 - Ogo, Atsushi

AU - Okamura, Shintaro

AU - Miyauchi, Shozo

AU - Yanase, Toshihiko

AU - Suzuki, Tomoko

AU - Kawamura, Takashi

PY - 2018/10/1

Y1 - 2018/10/1

N2 - Context: Primary aldosteronism (PA) in the elderly has increased in importance in association with population aging. Objective: To investigate the characteristics and outcomes of elderly patients with PA undergoing adrenalectomy. Patients and Methods: Using a database of patients with PA who underwent adrenal venous sampling (AVS),wecompared elderly patients (65 years old)with nonelderly patients (,65 years old) in terms of characteristics, subtype classification in ACTH-stimulated AVS, and outcomes after adrenalectomy. Results: The elderly group had a higher prevalence of comorbidities than the nonelderly group. The proportion of the unilateral subtype [defined as a lateralization index (LI) .4] was comparable between the age groups. In patients who received adrenalectomy, biochemical cure was comparable between the groups, whereas persistent hypertension was more common in the elderly group. The prevalences of hyperkalemia and renal impairment (chronic kidney disease stage 3b or higher) were higher in the elderly group. Multiple regression analysis showed that the duration of hypertension predicted persistent hypertension and hyperkalemia and that preoperative estimated glomerular filtration rate predicted renal impairment in the elderly group. LI .4 in AVS was an independent predictor of biochemical cure after adrenalectomy in the elderly group but not in the nonelderly group. Age was negatively associated with biochemical cure in patients with LI #4. Conclusion: Adrenalectomy contributes to biochemical improvement in elderly patients if determined in accordance with AVS. The treatment strategy should be determined considering the high postoperative incidence of persistent hypertension and hyperkalemia in elderly patients with a long history of hypertension or renal impairment in those with reduced renal function.

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