URINARY ALBUMIN EXCRETION CHANGES AFTER ADRENALECTOMY IN PATIENTS WITH PRIMARY ALDOSTERONISM

Abstract

Objective: We aimed to evaluate changes in urinary albumin excretion (UAE) in patients with primary aldosteronism (PA) after adrenalectomy compared with those who remained with non-surgical treatment. Design and method: We evaluated 28 patients with PA diagnosed by adrenal venous sampling (AVS), attended by hypertension specialists or endocrinologists in Hospital del Mar, Barcelona. Office blood pressure (BP), body weight and laboratory parameters (estimated glomerular filtration rate by CKD-EPI equation (eGFR), plasma potassium (K) and UAE) were analyzed before and at 6 months after adrenalectomy (Adx group) or before and 6 months after AVS (non-Adx group). Results: Most patients (66.7%) were male and the mean age was 55.8 ± 9.6 years. Twelve patients (42.8%) underwent adrenalectomy and 16 (57.1%) remained on pharmacological treatment alone. Spironolactone was the principal antihypertensive treatment in the non-Adx group (84.6% of patients). The proportion of diabetes mellitus was similar in both groups (12.5% in Adx group vs 16.2% in non-Adx group, p = 0.6). The decrease in BP was statistically significant in both groups (table 1). Adx group patients showed a statistically significant reduction in the UAE (-7.7 [-33.2 to -4.0] mg/g, p = 0.002) compared to patients in non-Adx group (+0.1 [-6.5 to + 24.9], p = 0.8). After six months, the mean reduction in UAE (log-transformed) was significantly superior in the Adx group than in the non-Adx group. After adjusting by variation of systolic-BP and variation of body weight, a mean difference between the two groups of -0.966 mmHg (95% CI -1.746 to -1.182); p = 0.018 was observed. Conclusions: Patients with PA who underwent adrenalectomy presented a higher reduction in UAE than patients who remained on pharmacological treatment alone.