ODP038 Efficacy of Medical Treatment Compared to Unilateral Adrenalectomy in a Cohort of Patients with Primary Aldosteronism Treated at the Centre Hospitalier Universitaire de Sherbrooke – CHUS

Abstract

Abstract Background Primary aldosteronism (PA) is associated with a high burden of cardiometabolic complications such as coronary heart disease, atrial fibrillation, left ventricular hypertrophy, stroke and chronic kidney disease. It is therefore essential to screen, confirm the diagnosis and then implement a targeted treatment, to lower the rate of these complications. According to the latest Endocrine Society guidelines for the management of PA, unilateral adrenalectomy is recommended when the secretion of aldosterone is mostly coming from one adrenal. If the secretion is bilateral or if the patient refuse surgery, medical treatment with mineralocorticoid receptor antagonist is indicated. Nevertheless, there are limited data comparing these two treatments on their impact on the number and dosage of anti-hypertensive drugs needed to control the disease. Objective The objective was to compare the impact of medical or surgical treatment on the antihypertensive defined daily dose (DDD) after 6 months of treatment in our cohort of PA patients followed at the CHUS. We've also evaluated the kalemia, blood pressure and renin after 6 and 12 months of treatment. Long term blood pressure control has also been evaluated. Methodology To answer this question, we conducted a single-center retrospective cohort study. Adults followed at CHUS between 2000 and 2021, with a confirmed diagnosis of PA and a follow-up of at least 6 months were included. Pregnancy was the only exclusion criteria. The primary outcome was the variation in the antihypertensiveDDD in patients medically treated compared to those surgically treated after 6 months. Results A total of 46 patients were included in our cohort, from which 28 were medically treated. Patients in the surgical group were younger, had a higher diastolic blood pressure and aldosterone/renin ratio. Among the 18 patients who underwent unilateral adrenalectomy, only 6 of them had a clearly lateralized secretion confirmed by adrenal veins sampling. At 6 months, the antihypertensive DDD variation was statistically significantly higher in the surgical group, with a decrease of 1.7 compared to a decrease of 0.6 in the medical group. Even after age, diastolic blood pressure and aldosterone/renin ratio adjustments, the difference between the 2 groups remains statistically significant, with a p value of 0. 033. Conclusion These results indicate that the surgical treatment of patient with primary aldosteronism leads to a greater DDD decrease at 6 months, even after adjusting for disease severity and despite the fact that the surgical group is not exclusively unilateral. However, the impact of disease control on long-term outcomes could not be assessed due to missing data. Presentation: No date and time listed