Abstract
BackgroundPrimary aldosteronism (PA) is the most common cause of secondary hypertension. Surgery is the mainstay of treatment for unilateral dominant PA, but reported cure rates varies. The aim of the present study was to investigate contemporary follow-up practices and cure rates after surgery for PA in Sweden.MethodsPatients operated for PA and registered in the Scandinavian Quality Register for Thyroid, Parathyroid and Adrenal Surgery (SQRTPA) 2009–2015 were identified. Patient data were extracted, and follow-up data (1–24 months) was recorded. Doses of antihypertensive medication and potassium supplementation were calculated using defined daily doses (DDD), and the Primary Aldosteronism Surgical Outcome (PASO) criteria were used to evaluate outcomes.ResultsOf 190 registered patients, 171 (47% female, mean age 53 years, median follow-up 3.7 months) were available for analysis. In 75 patients (44%), missing data precluded evaluation of biochemical cure according to the PASO criteria. Minimal invasive approach was used in 168/171 patients (98%). Complication rate (Clavien-Dindo >3a) was 3%. No mortality was registered. Pre/postoperatively 98/66% used antihypertensives (mean DDD 3.7/1.5). 89/2% had potassium supplementation (mean DDD 2.0/0) before/after surgery. Complete/partial biochemical and clinical success according to the PASO criteria were achieved in 92/7% and 34/60%, respectively.ConclusionIn this study, reflecting contemporary clinical practice in Sweden complete/partial biochemical and clinical success after surgery for PA was 92/7% and 34/60%. Evaluation of biochemical cure was hampered by lack of uniform reporting of relevant outcome measures. We suggest mandatory reporting of surgical outcomes using the PASO criteria for all units performing surgery for PA.
Highlights
Primary aldosteronism (PA) is a disease caused by an overproduction of aldosterone from the cortex of one or both adrenal glands [1]
In 75 patients (44%), missing data precluded evaluation of biochemical cure according to the Primary Aldosteronism Surgical Outcome (PASO) criteria
We suggest mandatory reporting of surgical outcomes using the PASO criteria for all units performing surgery for PA
Summary
Primary aldosteronism (PA) is a disease caused by an overproduction of aldosterone from the cortex of one or both adrenal glands [1]. A two to five times increased risk of myocardial infarction, coronary heart disease, heart failure and atrial fibrillation has been reported in patients with PA compared to matched patients with essential hypertension [7]. The recommended procedure to differentiate between unilateral and bilateral overproduction is adrenal venous sampling (AVS) [12]. Patients with bilaterally increased aldosterone production and patients with unilateral disease who are not candidates for surgery are best treated with mineralocorticoid receptor antagonists (MRA) [13], whereas unilateral dominant PA is a potentially surgically curable condition [14]. Surgery is the mainstay of treatment for unilateral dominant PA, but reported cure rates varies.
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