Predictors of Clinical Success after Surgery for Primary Aldosteronism in the Japanese Nationwide Cohort

Mitsuha Morisaki, Isao Kurihara, Hiroshi Itoh, Mitsuhide Naruse, Yoshiyu Takeda, Takuyuki Katabami, Takamasa Ichijo, Norio Wada, Takanobu Yoshimoto, Yoshihiro Ogawa, Masakatsu Sone, Mika Tsuiki, Hirotaka Shibata, Junji Kawashima, Megumi Fujita, Minemori Watanabe, Yuichi Matsuda, Hiroki Kobayashi, Tomoko Suzuki

Research output: Contribution to journalArticlepeer-review

4 Citations (Scopus)

Abstract

Context: Aldosterone-producing adenomas are a curable subtype of primary aldosteronism (PA); however, hypertension persists in some patients after adrenalectomy. Objective: To identify factors associated with, and develop prediction models for, blood pressure (BP) normalization or improvement after adrenalectomy. Design: Retrospective analysis of patients treated between 2006 and 2018, with a 6-month follow-up. Setting: A nationwide, 29-center Japanese registry encompassing 15 university hospitals and 14 city hospitals. Patients: We categorized 574 participants in the Japan Primary Aldosteronism Study, who were diagnosed with PA and underwent adrenalectomy, as BP normalized or improved, on the basis of their presentations at 6 months postsurgery. Main Outcome Measure: The rate of complete, partial, and absent clinical success. Predictive factors related to BP outcomes after PA surgery were also evaluated. Results: Complete clinical success was achieved in 32.6% and partial clinical success was achieved in 53.0% of the patients at 6 months postsurgery. The following five variables were independent predictors for BP normalization: ≤7 years of hypertension, body mass index ≤25 kg/m2, no more than one antihypertensive medication, absence of medical history of diabetes, and female sex. The area under the receiver operator characteristic curve was 0.797 in the BP normalization model. Conclusion: We established models that predicted postoperative BP normalization in patients with PA. These should be useful for shared decision-making regarding adrenalectomy for PA.

Original languageEnglish
Pages (from-to)2012-2022
Number of pages11
JournalJournal of the Endocrine Society
Volume3
Issue number11
DOIs
Publication statusPublished - 2019 Nov

Keywords

  • cure
  • hypertension
  • improvement
  • predictive model
  • primary aldosteronism
  • surgery

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism

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