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Araujo-Castro M, Pascual-Corrales E, Martín Rojas P, Parra Ramírez P. Primary aldosteronism: Practical recommendations for treatment and follow-up. HIPERTENSION Y RIESGO VASCULAR 2023; 40:215-221. [PMID: 37993292 DOI: 10.1016/j.hipert.2023.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 08/08/2023] [Accepted: 08/15/2023] [Indexed: 11/24/2023]
Abstract
Primary aldosteronism (PA) is the most common cause of secondary arterial hypertension. For unilateral cases, surgery offers the possibility of cure, with unilateral adrenalectomy being the treatment of choice, whereas bilateral forms of PA are treated mainly with mineralocorticoid receptor antagonists (MRA). The goals of treatment for PA due to either unilateral or bilateral adrenal disease include reversal of the adverse cardiovascular effects of hyperaldosteronism, normalization of serum potassium in patients with hypokalemia, and normalization of blood pressure. The Primary Aldosteronism Surgery Outcome group (PASO) published a study defining clinical and biochemical outcomes based on blood pressure and correction of hypokalemia and aldosterone to renin ratio (ARR) levels for patients undergoing total unilateral adrenalectomy for unilateral PA. In this review, we provide several practical recommendations for the medical and surgical management and follow-up of patients with PA.
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Affiliation(s)
- M Araujo-Castro
- Endocrinology & Nutrition Department, Hospital Universitario Ramón y Cajal, Madrid, Spain; Instituto de Investigación Biomédica Ramón y Cajal (IRYCIS), Spain; University of Alcalá, Madrid, Spain.
| | - E Pascual-Corrales
- Endocrinology & Nutrition Department, Hospital Universitario Ramón y Cajal, Madrid, Spain; Instituto de Investigación Biomédica Ramón y Cajal (IRYCIS), Spain
| | - P Martín Rojas
- Endocrinology & Nutrition Department, Hospital Universitario La Paz Madrid, Spain
| | - P Parra Ramírez
- Endocrinology & Nutrition Department, Hospital Universitario La Paz Madrid, Spain
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Zhang J, Yang J, Libianto R, Shen J, Fuller PJ, Grodski S, Lee JC. Impact of dedicated multidisciplinary service on patient selection and outcomes for surgical treatment of primary aldosteronism. Surgery 2022; 172:1682-1688. [PMID: 36123178 DOI: 10.1016/j.surg.2022.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 05/22/2022] [Accepted: 08/04/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Primary aldosteronism is the most common surgically curable cause of endocrine hypertension. Management of the unilateral subtype of primary aldosteronism with adrenalectomy requires multidisciplinary input. It is unclear if a dedicated endocrine hypertension service confers better outcomes compared to standard care offered by individual clinicians. METHODS In this retrospective study, patients from the Monash University Endocrine Surgery Database were divided into either the endocrine hypertension service group, where patients were managed by a dedicated multidisciplinary team, or the standard group, where patients were managed by individual clinicians. The comparisons included patient selection for surgery, perioperative blood pressure control, and surgical cure rate. RESULTS Despite similar perioperative blood pressure, patients in the endocrine hypertension service group (n = 41) were on fewer antihypertensive medications (1 vs 2, P = .011) compared to the standard group (n = 55). A larger proportion of patients in the endocrine hypertension service group had either bilateral adrenal nodules or no adrenal lesions on computed tomography (41% vs 18%, P = .013). Patients in the standard group had larger adrenal lesions on computed tomography (median 15 mm vs 10 mm, P = .032). Postoperatively, the biochemical cure rate was higher in the endocrine hypertension service group at 6 to 12 months (97% vs 76%, P = .021). CONCLUSION Patients managed by endocrine hypertension service were more likely to be diagnosed with surgically curable primary aldosteronism without a unilateral adrenal adenoma on imaging, required fewer medications for perioperative blood pressure control, and experienced superior postoperative outcomes. Referral to a dedicated endocrine hypertension service is recommended for patients with primary aldosteronism who wish to pursue a surgical cure.
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Affiliation(s)
- Jinghong Zhang
- Department of Endocrinology, Monash Health, Victoria, Australia. https://twitter.com/zhang_jinghong
| | - Jun Yang
- Department of Endocrinology, Monash Health, Victoria, Australia; Department of Medicine, Monash University, Victoria, Australia; Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Victoria, Australia. https://twitter.com/drlouisesegan
| | - Renata Libianto
- Department of Endocrinology, Monash Health, Victoria, Australia; Department of Medicine, Monash University, Victoria, Australia; Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Victoria, Australia
| | - Jimmy Shen
- Department of Endocrinology, Monash Health, Victoria, Australia; Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Victoria, Australia
| | - Peter J Fuller
- Department of Endocrinology, Monash Health, Victoria, Australia; Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Victoria, Australia
| | - Simon Grodski
- Monash University Endocrine Surgery Unit, Monash University, Victoria, Australia; Department of Surgery, Monash Health, Victoria, Australia; Department of Surgery, Central Clinical School, Monash University, Victoria, Australia
| | - James C Lee
- Monash University Endocrine Surgery Unit, Monash University, Victoria, Australia; Department of Surgery, Monash Health, Victoria, Australia; Department of Surgery, Central Clinical School, Monash University, Victoria, Australia.
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