Outcomes of Adrenalectomy and the Aldosteronoma Resolution Score in the Black and Hispanic Population

Gustavo Romero‐Velez,Michael K Parides,John C Mcauliffe,Steven K Libutti,Manuel E Barajas,Miguel F Herrera,Mauricio Sierra‐Salazar,Xavier Pereira,Amanda M Laird

doi:10.1007/s00268-021-05967-y

Abstract

BackgroundOutcomes after adrenalectomy in patients with primary aldosteronism (PA) are variable. The aldosteronoma resolution score (ARS) uses preoperative variables to calculate a score that identifies those patients that are more likely to have resolution of hypertension after adrenalectomy. We aim to determine the efficacy of adrenalectomy and whether the ARS accurately predicts clinical success in a Black and Hispanic population.MethodsWe reviewed patients who underwent adrenalectomy for PA from 2004 to 2018 at two academic centers treating primarily Hispanic and Black patients. Postoperative outcomes were evaluated based on the primary aldosteronism surgical outcome consensus criterion. Retrospectively, the accuracy of ARS was determined by a receiver operating characteristic curve and the area under the curve (AUC).ResultsForty-three Hispanic and 10 Black patients underwent adrenalectomy for PA. Twenty-two patients (41.5%) had complete clinical success. Variables associated with complete clinical success in the univariate analysis were female gender (p = 0.026), younger age (p = 0.001), lower preoperative aldosterone (p = 0.035), lower preoperative systolic blood pressure (p = 0.001), fewer number of preoperative antihypertensive medications (p = 0.007) and a higher ARS (p = 0.003). On multivariate analysis, only fewer number of preoperative antihypertensive medications was independently associated with complete clinical success (p = 0.026). The AUC of the ARS was 0.746.ConclusionThe rate of clinical success from adrenalectomy is good for Hispanic and Black patients with PA. Our analysis shows that the ARS is an accurate test of clinical success in Hispanic and Black patients. The ARS may be utilized preoperatively to frame expectations after adrenalectomy in these populations.

Highlights

Primary aldosteronism (PA) is present in up to 33% of patients with secondary hypertension (HTN) [1]
Fifty-three patients were included in the final analysis; 3 patients were excluded as their race was not Black nor Hispanic and one was excluded as the final pathology showed adrenocortical carcinoma
The aldosteronoma resolution score (ARS) may be used to predict the clinical success of a patient undergoing adrenalectomy for primary aldosteronism (PA)

Summary

Introduction

Primary aldosteronism (PA) is present in up to 33% of patients with secondary hypertension (HTN) [1]. It is characterized by renin-independent excess aldosterone which leads to drug-resistant hypertension and hypokalemia [2]. PA can be caused by bilateral adrenal hyperplasia, known as idiopathic hyper-aldosteronism (IHA). This distinction is important as IHA is typically treated with mineralocorticoid receptor antagonists while unilateral hypersecretion may be managed with adrenalectomy [3]. The aldosteronoma resolution score (ARS) uses preoperative variables to calculate a score that identifies those patients that are more likely to have resolution of hypertension after adrenalectomy. We aim to determine the efficacy of adrenalectomy and whether the ARS accurately predicts clinical success in a Black and Hispanic population

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Conclusion