PP.27.07] QUALITY OF LIFE IN PRIMARY ALDOSTERONISM IMPROVES MORE AFTER ADRENALECTOMY THAN AFTER MEDICAL THERAPY

Abstract

Objective: To compare the effects of surgical and medical treatment on health-related quality of life (QoL) in primary aldosteronism Design and method: We did a post-hoc comparative effectiveness study within the SPARTACUS trial (n = 184) in thirteen hospitals. In case of aldosterone-producing adenoma we performed an adrenalectomy and for bilateral adrenal hyperplasia we treated patients with mineralocorticoid receptor antagonists. At baseline, six months and one year follow-up we assessed QoL by two validated questionnaires. Results: At baseline, seven out of eight RAND SF-36 subscales and both summary scores and three out of five EQ-5D dimensions and the visual analogue scale were lower in PA patients compared to the general population. The beneficial effects of adrenalectomy were larger than for mineralocorticoid receptor antagonists for seven RAND SF-36 subscales, both summary scores, and health change. For the EQ-5D, we detected a difference in favour of adrenalectomy in two of the five dimensions and the visual analogue scale. Most differences in QoL between both treatments exceeded the minimally clinically important difference. After one year we observed improvement of most QoL measures for both treatments, but only for adrenalectomy all returned to the level of the general population. Conclusions: Both treatments clearly improve QoL of patients with PA, underscoring the importance of identifying these patients. Improvement in QoL in patients with PA one year after surgical treatment for suspected aldosterone-producing adenoma is superior to that of medically treated patients with suspected bilateral adrenal hyperplasia.