Outcomes after adrenalectomy for unilateral primary aldosteronism: an international consensus on outcome measures and analysis of remission rates in an international cohort
| Autor: | Tracy A Williams, Jacques W M Lenders, Paolo Mulatero, Jacopo Burrello, Marietta Rottenkolber, Christian Adolf, Fumitoshi Satoh, Laurence Amar, Marcus Quinkler, Jaap Deinum, Felix Beuschlein, Kanako K Kitamoto, Uyen Pham, Ryo Morimoto, Hironobu Umakoshi, Aleksander Prejbisz, Tomaz Kocjan, Mitsuhide Naruse, Michael Stowasser, Tetsuo Nishikawa, William F Young, Celso E Gomez-Sanchez, John W Funder, Martin Reincke, Tracy Ann Williams, Richard J Auchus, Detlef K Bartsch, Rene Baudrand, Peyman Björklund, Morris J Brown, Robert M Carey, Cristiana Catena, John M Connell, Tanja Dekkers, Thomas J Fahey, Francesco Fallo, Carlos E. Fardella, Gilberta Giacchetti, Giuseppe Giraudo, Per Hellman, Andrzej Januszewicz, Kanako Kiriyama Kitamoto, Gregory A Kline, Franco Mantero, Barbra S Miller, Pierre-François Plouin, Alexander Prejbisz, Christian L Rump, Leonardo A Sechi, Franco Veglio, Jirí Widimský, Holger S Willenberg |
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| Přispěvatelé: | University of Zurich, Reincke, Martin |
| Rok vydání: | 2017 |
| Předmět: |
Male
Pediatrics Delphi Technique Endocrinology Diabetes and Metabolism Vascular damage Radboud Institute for Health Sciences [Radboudumc 16] 10265 Clinic for Endocrinology and Diabetology Blood Pressure 030204 cardiovascular system & hematology Internal Medicine Endocrinology 0302 clinical medicine Primary aldosteronism primary aldosteronism adrenal aldosterone Outcome Assessment Health Care Prospective Studies Prospective cohort study media_common Adrenalectomy Middle Aged 1310 Endocrinology 3. Good health Diabetes and Metabolism 2712 Endocrinology Diabetes and Metabolism Hypertension Cohort Female Cohort study Adult medicine.medical_specialty Consensus 610 Medicine & health 030209 endocrinology & metabolism Article 03 medical and health sciences Hyperaldosteronism medicine media_common.cataloged_instance Humans European union Retrospective Studies primary aldosteronism aldosterone business.industry Retrospective cohort study Odds ratio Guideline medicine.disease Surgery adrenal 2724 Internal Medicine business |
| Zdroj: | The Lancet Diabetes & Endocrinology Lancet Diabetes & Endocrinology, 5, 689-699 Lancet Diabetes & Endocrinology, 5, 9, pp. 689-699 |
| ISSN: | 2213-8587 |
| Popis: | Item does not contain fulltext BACKGROUND: Although unilateral primary aldosteronism is the most common surgically correctable cause of hypertension, no standard criteria exist to classify surgical outcomes. We aimed to create consensus criteria for clinical and biochemical outcomes and follow-up of adrenalectomy for unilateral primary aldosteronism and apply these criteria to an international cohort to analyse the frequency of remission and identify preoperative determinants of successful outcome. METHODS: The Primary Aldosteronism Surgical Outcome (PASO) study was an international project to develop consensus criteria for outcomes and follow-up of adrenalectomy for unilateral primary aldosteronism. An international panel of 31 experts from 28 centres, including six endocrine surgeons, used the Delphi method to reach consensus. We then retrospectively analysed follow-up data from prospective cohorts for outcome assessment of patients diagnosed with unilateral primary aldosteronism by adrenal venous sampling who had undergone a total adrenalectomy, consecutively included from 12 referral centres in nine countries. On the basis of standardised criteria, we determined the proportions of patients achieving complete, partial, or absent clinical and biochemical success in accordance with the consensus. We then used logistic regression analyses to identify preoperative factors associated with clinical and biochemical outcomes. FINDINGS: Consensus was reached for criteria for six outcomes (complete, partial, and absent success of clinical and biochemical outcomes) based on blood pressure, use of antihypertensive drugs, plasma potassium and aldosterone concentrations, and plasma renin concentrations or activities. Consensus was also reached for two recommendations for the timing of follow-up assessment. For the international cohort analysis, we analysed clinical data from 705 patients recruited between 1994 and 2015, of whom 699 also had biochemical data. Complete clinical success was achieved in 259 (37%) of 705 patients, with a wide variance (range 17-62), and partial clinical success in an additional 334 (47%, range 35-66); complete biochemical success was seen in 656 (94%, 83-100) of 699 patients. Female patients had a higher likelihood of complete clinical success (odds ratio [OR] 2.25, 95% CI 1.40-3.62; p=0.001) and clinical benefit (complete plus partial clinical success; OR 2.89, 1.49-5.59; p=0.002) than male patients. Younger patients had a higher likelihood of complete clinical success (OR 0.95 per extra year, 0.93-0.98; p |
| Databáze: | OpenAIRE |
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