ECE2014 Poster Presentations Adrenal cortex (56 abstracts)
Cardiovascular outcome in patients with primary aldosteronism following adrenalectomy and mineralocorticoid antagonist treatment: prospective results of the Munich Conn Center
Anna Riester 1 , Evelyn Fischer 1 , Christoph Degenhart 2 , Martin Bidlingmaier 1 , Klaus Hallfeldt 3 , Felix Beuschlein 1 & Martin Reincke 1
1Medizinische Klinik und Poliklinik IV, Klinikum der Ludwig-Maximilians-Universität München, Munich, Germany; 2Klinische Radiologie, Klinikum der Ludwig-Maximilians-Universität München, Munich, Germany; 3Chirurgische Klinik und Poliklinik - Innenstadt, Klinikum der Ludwig-Maximilians-Universität München, Munich, Germany.
The cardiovascular outcome of targeted treatment of primary aldosteronism (PA) has not been prospectively studied in large cohorts. Using the data of the prospective German Conn’s registry we evaluated the effect of adrenalectomy (ADX) vs mineralocorticoid-receptor-antagonists (MRA) treatment on blood pressure (BP), serum potassium, eGFR, pro-BNP, number and WHO DDD of antihypertensive drugs. Since 2008, 181 patients have been newly diagnosed with PA and underwent subtype differentiation using adrenal vein sampling in Munich. 86 patients (53 with aldosterone producing adenoma (APA) and 33 with idiopathic adrenal hyperplasia (IAH); 36% female, median age 53 years, mean BP 153/93 mmHg, 92% hypokalemic) underwent a standardized follow-up investigation 1 year after diagnosis, and 15 patients had 3 years of follow-up. At diagnosis, 58% of patients with APA and 67% patients with IAH had resistant or WHO grade ≥2 hypertension. One year after intervention, mean BP fell in the APA group from 152/93 to 133/85 mmHg, with 25% patients having resistant or WHO grade ≥2 BP, and 19% were normotensive without medication. In the IAH group, blood pressure fell from 154/93 to 137/86 mmHg, with 42% patients having resistant or WHO grade ≥2 BP. A significant lower number and DDD of antihypertensive drugs (median number in APA 1 (2) vs 3 (2) in IAH; P<0.001) was observed in the APA group. The decrease in eGFR was similar in both groups (−8.9 vs −4.8 ml/min per 1.73 m2; P=0.25), whereas the increase in potassium was more pronounced in the APA group (+1.0 vs +0.8 mmol/l; P<0.05). Treatment effects were similar in patients of >60 years (n=18). At 3-year follow-up no differences between the two groups was seen.
These data demonstrate that MRA treatment in PA is effective with regard to BP control, but that ADX can lead to a cure of hypertension in about one fifth of the patients.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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