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Re-evaluating absent clinical success after adrenalectomy in unilateral primary aldosteronism
- Source :
- Surgery. 170:1389-1396
- Publication Year :
- 2021
- Publisher :
- Elsevier BV, 2021.
-
Abstract
- Background Adrenalectomy cures unilateral primary aldosteronism, and it improves or cures hypertension. However, a significant proportion of patients are classified with absent clinical success postsurgery, suggesting that surgery was ineffective. Methods We assessed all patients 6 to 12 months post-surgery for clinical outcomes using Primary Aldosteronism Surgical Outcomes (PASO), AVIS-2, and CONNsortium criteria. We estimated blood pressure changes after adjustment for changes in defined daily dosages of antihypertensive medications. We also reassessed all patients using PASO at their recent clinical visit. Results A total of 104 patients with unilateral primary aldosteronism underwent adrenalectomy at 2 tertiary centers from 2000 to 2019; 24 (23%), 31 (30%), and 54 (52%) patients were classified with absent clinical success using PASO, AVIS-2, and CONNsortium criteria, respectively. Among 24 patients with absent clinical success using PASO criteria, 10 had complete biochemical cure, 3 partial, 2 absent, and 9 had resolution of hypokalemia. On multivariable analysis, absent clinical success was associated with presence of hyperlipidemia, diabetes mellitus, and lower defined daily dosages at baseline. After adjustment for changes in defined daily dosages, 7 of 24 patients showed blood pressure improvement ≥20/10 mm Hg post-surgery. After a follow-up of mean 5.6 years, 12 of 24 patients showed partial or complete clinical success when reassessed using PASO criteria. Only 6 of 104 (5.8%) patients failed to show clinical improvement post-surgery using any of the 3 mentioned criteria or using PASO criteria at their recent clinical visit. Conclusion Although some patients may be classified with absent clinical success post-surgery, the assessment of clinical outcomes remains subject to many variables. In patients with unilateral primary aldosteronism, evidenced by lateralization on AVS, unilateral adrenalectomy should remain the recommended treatment.
- Subjects :
- Male
medicine.medical_specialty
Dose
medicine.medical_treatment
Blood Pressure
030230 surgery
Clinical success
03 medical and health sciences
0302 clinical medicine
Primary aldosteronism
Diabetes mellitus
Internal medicine
Hyperaldosteronism
Outcome Assessment, Health Care
Hyperlipidemia
Humans
Medicine
Antihypertensive Agents
Retrospective Studies
Postoperative Care
business.industry
Adrenalectomy
Middle Aged
medicine.disease
Hypokalemia
Treatment Outcome
Blood pressure
030220 oncology & carcinogenesis
Hypertension
Female
Surgery
medicine.symptom
business
Follow-Up Studies
Subjects
Details
- ISSN :
- 00396060
- Volume :
- 170
- Database :
- OpenAIRE
- Journal :
- Surgery
- Accession number :
- edsair.doi.dedup.....1f3d1393495bc0e3b46d1033ad6b1c5e