Clinical outcomes following unilateral adrenalectomy in patients with primary aldosteronism.
QJM
; 110(5): 277-281, 2017 May 01.
Article
in En
| MEDLINE
| ID: mdl-28180906
ABSTRACT
BACKGROUND:
In approximately half of cases of primary aldosteronism (PA), the cause is a surgically-resectable unilateral aldosterone-producing adrenal adenoma. However, long-term data on surgical outcomes are sparse.AIM:
We report on clinical outcomes post-adrenalectomy in a cohort of patients with PA who underwent surgery.DESIGN:
Retrospective review of patients treated for PA in a single UK tertiary centre.METHODS:
Of 120 consecutive patients investigated for PA, 52 (30 male, median age 54, range 30-74) underwent unilateral complete adrenalectomy. Blood pressure, number of antihypertensive medications, and serum potassium were recorded before adrenalectomy, and after a median follow-up period of 50 months (range 7-115). Recumbent renin and aldosterone were measured, in the absence of interfering antihypertensive medication, ≥3months after surgery, to determine if PA had been biochemically cured.RESULTS:
Overall, blood pressure improved from a median (range) 160/95 mmHg (120/80-250/150) pre-operatively to 130/80 mmHg (110/70-160/93), P < 0.0001. 24/52 patients (46.2%) had cured hypertension, with a normal blood pressure post-operatively on no medication. 26/52 (50%) had improved hypertension. 2/52 patients (3.8%) showed no improvement in blood pressure post-operatively. Median (range) serum potassium level increased from 3.2 (2.3-4.7) mmol/l pre-operatively to 4.4 mmol/l (3.3-5.3) post-operatively, P < 0.0001). Median (range) number of antihypertensive medications used fell from 3 (0-6) pre- to 1 post-operatively (range 0-4), P < 0.0001.CONCLUSIONS:
Unilateral adrenalectomy provides excellent long-term improvements in blood pressure control, polypharmacy and hypokalaemia in patients with lateralizing PA. These data may help inform discussions with patients contemplating surgery.
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Adrenalectomy
/
Hyperaldosteronism
Type of study:
Etiology_studies
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Limits:
Adult
/
Aged
/
Aged80
/
Female
/
Humans
/
Male
/
Middle aged
Language:
En
Journal:
QJM
Journal subject:
MEDICINA
Year:
2017
Document type:
Article
Affiliation country:
United kingdom