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 language | English |
|---|---|
| Pages (from-to) | 3620-3629 |
| Number of pages | 10 |
| Journal | Journal of Clinical Endocrinology and Metabolism |
| Volume | 103 |
| Issue number | 10 |
| DOIs | |
| Publication status | Published - 2018 Oct 1 |
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ASJC Scopus subject areas
- Endocrinology, Diabetes and Metabolism
- Biochemistry
- Endocrinology
- Clinical Biochemistry
- Biochemistry, medical
Cite this
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 journal › Article
}
TY - JOUR
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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=85054451250&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85054451250&partnerID=8YFLogxK
U2 - 10.1210/jc.2018-00059
DO - 10.1210/jc.2018-00059
M3 - Article
C2 - 30099522
AN - SCOPUS:85054451250
VL - 103
SP - 3620
EP - 3629
JO - Journal of Clinical Endocrinology and Metabolism
JF - Journal of Clinical Endocrinology and Metabolism
SN - 0021-972X
IS - 10
ER -