Outcome Success After Surgical Treatment For Primary Hyperaldosteronism
*Bryan W Whitfield, *Omar Picado, *Zahra F Khan, *Josefina C. Farra, John I. Lew
University of Miami, Miami, FL
OBJECTIVE(S): Primary hyperaldosteronism (PH) is a common and worldwide cause of secondary hypertension. Clinical resolution of uncontrolled hypertension compared to its underlying biochemical abnormalities after surgical resection of a unilateral adrenal tumor for PH is variable. This study examines outcome success after laparoscopic adrenalectomy in patients with unilateral PH.
METHODS: Patients who underwent surgical resection for adrenal tumors at a single institution from 2010-2018 were reviewed. Demographic, clinical, biochemical, and pathologic data of patients with PH were collected. Clinical success was defined as decreased number of antihypertensive medications and lowered blood pressure postoperatively. Biochemical success was defined as normalization of hypokalemia and aldosterone-to-renin ratio postoperatively. Descriptive statistics for median and interquartile range (IQR), frequencies and percentages, and binary logistic regression analysis for factors associated with uncontrolled hypertension were used.
RESULTS: Of 202 patients who underwent unilateral and laparoscopic adrenalectomy, 37 (18%) had biochemical confirmation for PH. All 37 patients underwent initial laparoscopic anterior (92%, n=34) or posterior (8%, n=3) adrenalectomy. Median age was 50 years, and 60% were women with median duration of hypertension of 10 years (IQR: 1.5-20 years). Average body mass index (BMI) was 29 kg/m2. Biochemical profile demonstrated median serum potassium of 3.3 mmol/L (IQR: 2.8-3.8 mmol/L), aldosterone level of 28 ng/dL (IQR: 17-43 ng/dL), and plasma renin activity of 0.16 ng/mL/h (0.11-0.30 ng/mL/h). Median tumor size was 1.8 cm (1-2.5 cm). Postoperatively, complete clinical success was achieved in 15 (41%), partial clinical success in 14 (38%), and absent in 8 (21%) patients. Increased BMI (OR: 1.13, 95% CI: 1.01-1.29, p=0.04), duration of hypertension (OR=1.11 per year, 95% CI: 1.03-1.25, p=0.04), and number of antihypertensives (OR: 2.30 per medication, 95% CI: 1.07-4.93, p=0.03) were associated with absent clinical success. Biochemical success was achieved in all 37 (100%) patients with a median follow-up of 27 months. Three patients (8%) with complete clinical success redeveloped hypertension on average 4-years after adrenalectomy.
CONCLUSIONS: Resolution of biochemical abnormalities occurs more frequently than hypertension after adrenalectomy in patients with unilateral adrenal tumors for PH. High BMI, longstanding hypertension and several antihypertensive medications are preoperative factors associated with absent clinical success.
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