Re-evaluating absent clinical success after adrenalectomy in unilateral primary aldosteronism
| Autor: | Donovan Tay, Lih Ming Loh, Lynette Lee, Ling Zhu, Tunn Lin Tay, Ying Tan, Roger Foo, Du Soon Swee, Wann Jia Loh, Troy H Puar, Joan Khoo, Rehena Sultana, Dawn Shao Ting Lim, Peng Chin Kek, Keng Sin Ng, Meifen Zhang, Vanessa Au, Yvonne Hui Bin Chan, Sarah Y Tan |
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| Rok vydání: | 2021 |
| Předmět: |
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 |
| Zdroj: | Surgery. 170:1389-1396 |
| ISSN: | 0039-6060 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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