EXPLORATION OF SCREENING FOR PRIMARY ALDOSTERONISM BY IMMUNOHISTOCHEMISTRY IN PATIENTS WITH ADRENAL SURGERY IN CHINESE

Abstract

Objective: Primary aldosteronism (PA) is common secondary hypertension, however, the screening rate for PA is not entirely satisfactory. This study aimed to use immunohistochemical staining for retrospective analysis of screening for PA in patients with adrenal surgery in Chinese to improve the screening rate of PA. Design and method: A total of 101 patients who were diagnosed with adrenal tumors and treated with adrenalectomy were collected. Immunohistochemical staining for anti-CYP11B1 and anti-CYP11B2 monoclonal antibodies was performed on postoperative specimens. Analysis of staining results according to the expert consensus on the histopathology of PA. Results: Of the 101 patients included, 25 (24.75%) patients had completed secondary hypertension screening before surgery. Of the remaining 76 (75.25%) patients, immunohistochemical staining was identified in 13 patients (12.87%) with PA and 4 patients (3.96%) with autonomous secretion of cortisol. Only APM or MAPM was seen in 42 patients (41.58%). APM and MAPM were used as a potential diagnostic basis leading to PA, and functional lesions were observed in postoperative pathology in 83.17% of patients. Still, 16.83% of patients did not show clear functional histopathology on pathological staining. The overall incidence of APM and MAPM was 64.36%. Increased prevalence of APM and MAPM in patients older than or equal to 50 years old compared to patients younger than 50 years old (67.14% versus. 58.06%) and in female patients compared to males (77.78% versus. 42.11%). There without a significant difference between different ages (χ2 = 0.772, P = 0.380) but there was a significant difference between genders (χ2 = 13.149, P < 0.001). Conclusions: The screening rate of PA before adrenalectomy was less than 1/4. More than 40% of patients had pathologically confirmed APM or MAPM without systematic PA screening. Meanwhile, 16.83% of patients undergoing adrenal surgery had no clear functional histopathological manifestations. The problem of inadequate screening for PA still exists. Immunohistochemistry by anti-CYP11B1 and anti-CYP11B2 monoclonal antibodies is an important tool in the pathological diagnosis of PA and will help identify potential autonomous secretion of aldosterone and guide improved screening for PA.