PD31-02 WHAT TIMING IS APPROPRIATE FOR A BIOCHEMICAL EVALUATION AFTER LAPAROSCOPIC ADRENALECTOMY FOR UNILATERAL ALDOSTERONE-PRODUCING ADENOMA?

Abstract

INTRODUCTION AND OBJECTIVE: The over-secretion of plasma aldosterone by unilateral aldosterone-producing adenoma (APA) can be cured by adrenalectomy. However, the time needed for the endocrine environment to normalize remains unclear. The aim of this study is to clarify adequate timing for a biochemical evaluation in unilateral APA patients after adrenalectomy. METHODS: A total of 166 unilateral APA patients were retrospectively reviewed. We evaluated renin-angiotensin axis agents: the plasma aldosterone concentration (PAC) (pg/ml), active renin concentration (ARC) (pg/ml) and aldosterone-renin ratio (ARR: PAC/ARC), serum potassium concentration, and estimated glomerular filtration rate (eGFR) at 1, 3, and 6 post operation months (POM). By applying the Primary Aldosteronism Surgical Outcome criteria, which is based with ARR, PAC and serum potassium levels, biochemical outcomes were also evaluated. RESULTS: PAC was significantly lower at 1POM than at pre-surgery (pre-surgery; 407.2, 1 POM; 90.0 pg/mL, p<0.001) (Fig. A). ARC did not increase from baseline at 1POM, but significantly increased at 3POM (pre-surgery; 4.43, 1POM; 4.87, 3POM; 11.3 pg/mL, p<0.001) (Fig. B). The patients who didn’t achieve the ARC normalization at 1POM had lower pre-surgery ARC (p<0.001) and higher pre-surgery 24-hour urinary aldosterone excretion (p=0.042). Although ARC did not significantly increase at 1POM, ARR significantly decreased at 1POM (pre-surgery; 146.9, 1 POM; 26.3, p<0.001) (Fig. C). Among the 34 patients who had hypokalemia pre-surgery, it was resolved in 28 (82%) at 1POM and in all (100%) at 3POM (Fig. D). The biochemical outcomes at 1POM were 131 (79%) complete, 20 (12%) partial, and 15 (9%) absent successes, while at 3POM, 147 (89%) were complete, 9 (5%) partial, and 10 (6%) absent. Twenty-three (14%) patients were changed biochemical outcomes between 1 and 3POM, whereas only 5 (3%) changed between 3 and 6POM. CONCLUSIONS: The appropriate timing for a biochemical evaluation of unilateral APA patients treated with laparoscopic adrenalectomy appears to be 3 months or more after surgery.Source of Funding: None