Effect of Treatment on Body Fluid in Patients with Unilateral Aldosterone Producing Adenoma

Abstract

Background: There is limited information about the effect of prolonged aldosterone excess and treatment on body fluid. Objective: To investigate the effects of adrenalectomy versus spironolactone treatment on body composition in primary aldosteronism (PA) patients with unilateral aldosterone producing adenoma (APA). Method: We determined body composition changes assessed by a bio-impedance spectroscopy device, the Body Composition Monitor (BCM). We examined pretreatment relative overhydration (%), relative fat (%) and relative lean tissue mass (%) in PA patients with APA and followed-up with patients after adrenalectomy or spironolactone treatment. We also assessed biomarkers related to fluid overload. Results: This prospective, multicenter study included 41 PA patients with APA. Twenty-one patients received adrenalectomy, whereas 20 patients were treated with spironolactone. Patients with APA receiving adrenalectomy, as compared with those treated with spironolactone, had significantly lower relative OH (p = 0.011) and urine albumin excretion (p = 0.003), and significantly higher urine sodium excretion (p < 0.001) and relative fat (p = 0.034) four weeks after treatment. These differences dissipated 12 weeks after the initial treatment. Patients who underwent adrenaelctomy had significantly decreased TNF-α and increased serum potassium level when compared to patients treated with spironolactone 4 and 12 weeks after treatment. Conclusions: In this pilot study, we found that adrenalectomy leads to the normalization of plasma aldosterone concentration followed by an earlier increase in renal sodium excretion and decreases in body fluid content, TNF-α, and urine albumin excretion. Adrenalectomy yields a therapeutic effect more rapidly, which has been shown to ameliorate overhydration in PA patients.