TREATMENT OF PRIMARY ALDOSTERONISM: SHORT AND MIDDLE-TERM EFFECTS OF MEDICAL AND SURGICAL THERAPY IN PRIMARY HYPERALDOSTERONISM. EXPERIENCE ON 45 CASES: PP.18.187

Abstract

Primary Hyperaldosteronism (PA), the most common causes of secondary hypertension, may be associated with hypokaliemia, cardiac and renal damage. Recommended treatment in unilateral PA is adrenalectomy, while medical treatment with mineralocorticoid receptor antagonists (MRA) is indicated bilateral adrenal diseases. We present our recent experience in a series of patients with PA. Aim of our study was to evaluate short and middle-term effects of medical and surgical treatment on hypertensive state, hormonal parameters and cardiac function in 45 patients with PA referred to our centre between 2005 and 2008. In all patients after confirmation of PA, ECG and echocardiography were performed at baseline and after treatment with adrenalectomy (n = 22) or MRA (n = 23) every 12 months with a median follow-up of 36 months. At baseline 82% presented moderate or severe hypertension, 66% hypokaliemia. Echocardiography measurement shows left ventricular hypertrophy in 69% of patients, 93% with concentric geometry; 40% presents reduced diastolic function and 4% reduced systolic function. After treatment both groups presented various degrees of blood pressure reduction (60% normalization after adrenalectomy, 82% on medical treatment) and 100% normokaliemia. In adrenalectomized patients there was a significant reduction of plasma aldosterone concentration (PAC) and normalization of ARR ratio. In medically treated patients we observed significant normalization of plasma renin activity (PRA) and consequently normalization of ARR. In both there was a significant reduction of LVMI, greater in the 1 year period in adrenalectomized patients, reduction of RWT only in adrenalectomized patients. Prevalence of hypertrophy decreased in both groups, diastolic parameters had no significant improvement. Changes of LVMI were significantly correlated with changes in diastolic blood pressure in both and with PAC reduction only in adrenalectomized patients. Thus, in the short-middle term, both Treatments are effective in normalization of plasma potassium, reduction of BP and ARR. Adrenalectomy seems to be more effective in the short-term in reduction of LVM and RWT, while both treatments are less effective in improving systolic and diastolic function.