652 LONG-TERM TREATEMENT WITH ALDOSTERONE BLOCKER CAN CAUSE SPONTANEOUSLY REMISSION IN PATIENTS WITH PRIMARY ALDOSTERONISM

Abstract

Purpose: Primary aldosteronism (PA) is mainly caused by aldosterone producing adenoma and idiopathic bilateral adrenal hyperplasia (IHA). Laparoscopicadrenalectomy is recommended for the treatment of APA. Medical treatment with a mineralocorticoid receptor (MR) antagonist such as spironolactone (SP) or eplerenone(EP) is recommended for patients with IHA. Fishcher et al reported that the prevalence of spontaneous remission of IHA during long-term treatment with SP was 5.4% (Clin Endocrinol 2011). We aimed to determine the prevalence of spontaneous remission of PA during long-term treatment with MR antagonists (SP or EP) in Japan. Methods: 56 patients with PA (APA, 9 cases; IHA, 26 cases; others, 21 cases) treated with MR antagonists during more than 3 years were investigated. 36 patients were treated with SP. 20 patients were treated with EP. The patients were identified retrospectively by chart review and prospectively assessed by clinical and biochemical means. We defined complete remission (CR) of PA as normal aldosterone to renin ratio (ARR), normal suppression test, normalization of hypokalemia without hypertension. Partial remission (PR) was defined as normalization of ARR, normal suppression test, normalization of hypokalemia with hypertension. Results: The mean period of MR antagonist treatment was 4.1 years in the patients. We identified 2 (APA, 1 and IHA, 1) of 56 (3.6%) patients with CR. We also identified 8 (4 patients treated with EP; 4 patients treated with SP) (14.3%) of 56 patients with PR. Conclusions: Partial remission of PA after long-term mineralocorticoid antagonist treatment in Japan is more frequent than previously reported.