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Clinical and biochemical outcomes after adrenalectomy and medical treatment in patients with unilateral primary aldosteronism

Katabami, Takuyukia; Fukuda, Hisashia; Tsukiyama, Hidekazua; Tanaka, Yasushib; Takeda, Yoshiyuc; Kurihara, Isaod; Ito, Hiroshid; Tsuiki, Mikae; Ichijo, Takamasaf; Wada, Noriog; Shibayama, Yuig; Yoshimoto, Takanobuh; Ogawa, Yoshihiroi; Kawashima, Junjij; Sone, Masakatsuk; Inagaki, Nobuyak; Takahashi, Katsutoshil; Fujita, Megumim; Watanabe, Minemorin; Matsuda, Yuichio; Kobayashi, Hirokip; Shibata, Hirotakaq; Kamemura, Koheir; Otsuki, Michios; Fujii, Yuichit; Yamamoto, Koichiu; Ogo, Atsushiv; Yanase, Toshihikow; Suzuki, Tomokox; Naruse, Mitsuhidey JPAS/JRAS Study Group

doi: 10.1097/HJH.0000000000002070

Objectives: Current clinical guidelines of primary aldosteronism recommend adrenalectomy (AdX) for unilateral primary aldosteronism based on the studies showing the potential superiority of AdX over the medical treatment. However, since most medically treated cases consisted of bilateral primary aldosteronism and all surgically treated cases consisted of unilateral primary aldosteronism, the different subtype of primary aldosteronism could be a bias for their effects. This study compared the effects of AdX and medical therapy in patients with unilateral primary aldosteronism confirmed by adrenal vein sampling.

Methods: Of the 339 patients with unilateral primary aldosteronism in the Japan Primary Pldosteronism Study data base, unilateral AdX and treatment with mineral corticoid receptor antagonists (MRAs) was done in 276 patients (AdX group) and in 63 patients (MRAs group), respectively. The effects were compared by the clinical (improvement of blood pressure) and biochemical outcomes (improvement of hypokalemia).

Results: At baseline, use of potassium replacement, plasma aldosterone concentration, aldosterone-to-renin ratio, estimated glomerular filtration rate, and prevalence of adrenal mass on imaging were higher in the AdX group than in the MRAs group. At 6 months after commencement of specific treatment for primary aldosteronism, clinical outcome and biochemical outcome in the AdX group were superior than those in the MRAs group. The difference of the outcome between the two groups were the case even after adjusting for the different clinical backgrounds in the two groups before the specific treatment.

Conclusion: Our study provides evidence that AdX is the first choice of treatment in the patients with unilateral primary aldosteronism in terms of clinical and biochemical outcome.

aDivision of Metabolism and Endocrinology, Department of Internal Medicine, St. Marianna University School of Medicine Yokohama City Seibu Hospital, Yokohama

bDivision of Metabolism and Endocrinology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki

cDepartment of Internal Medicine, Graduate School of Medical Science, Kanazawa University, Kanazawa

dDepartment of Endocrinology, Metabolism and Nephrology, School of Medicine Keio University, Tokyo

eDepartment of Endocrinology and Metabolism, National Hospital Organization Kyoto Medical Center, Kyoto

fDepartment of Endocrinology and Metabolism, Saiseikai Yokohamashi Tobu Hospital, Yokohama

gDepartment of Diabetes and Endocrinology, Sapporo City General Hospital, Sapporo

hDepartment of Molecular Endocrinology and Metabolism, Tokyo Medical and Dental University, Tokyo

iDepartment of Medicine and Bioregulatory Science, Graduate School of Medical Science, Kyushu University, Fukuoka

jDepartment of Metabolic Medicine, Faculty of Life Science, Kumamoto University, Kumamoto

kDepartment of Diabetes, Endocrinology and Nutrition, Kyoto University, Kyoto

lDivision of Metabolism, Showa General Hospital

mDivision of Nephrology and Endocrinology, The University of Tokyo, Tokyo

nDepartment of Endocrinology and Diabetes, Okazaki City Hospital, Okazaki

oDepartment of Cardiology, Sanda City Hospital, Sanda

pDivision of Nephrology, Hypertension and Endocrinology, Nihon University School of Medicine, Tokyo

qDepartment of Endocrinology, Metabolism, Rheumatology and Nephrology, Faculty of Medicine, Oita University, Yufu

rDepartment of Cardiology, Akashi Medical Center, Akashi

sDepartment of Metabolic Medicine, Osaka University Graduate School of Medicine, Osaka

tDepartment of Cardiology, JR Hiroshima Hospital, Hiroshima

uDepartment of Geriatric and General Medicine, Osaka University Graduate School of Medicine, Osaka

vClinical Research Institute, National Hospital Organization Kyusyu Medical Center

wDepartment of Endocrinology and Diabetes Mellitus, Faculty of Medicine, Fukuoka University, Fukuoka

xDepartment of Public Health, School of Medicine, International University of Health and Welfare, Narita

yClinical Research Institute of Endocrinology and Metabolism, Kyoto Medical Center, National Hospital Organization, Kyoto, Japan

Correspondence to Takuyuki Katabami, MD, PhD, Division of Metabolism and Endocrinology, Department of Internal Medicine, St. Marianna University School of Medicine Yokohama City Seibu Hospital, 1197-1, Yasashicho, Asahi-ku, Yokohama, Kanagawa 241-0811, Japan. Tel: +81 45 366 1111; fax: +81 45 366 8503; e-mail:

Abbreviations: AdX, adrenalectomy; ARC, active renin concentration; ARR, aldosterone-to-renin ratio; AVS, adrenal vein sampling; BP, blood pressure; CVE, cardiovascular event; DDD, defined daily dose; eGFR, estimated glomerular filtration rate; JPAS, Japan Primary Pldosteronism Study; MRA, mineral corticoid receptor antagonist; PAC, plasma aldosterone concentration; PASO, primary aldosteronism surgical outcome; PRA, plasma renin activity

Received 5 November, 2018

Revised 7 January, 2019

Accepted 22 January, 2019

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