Endocrine Abstracts

Background: Although unilateral primary aldosteronism (PA) is the most common surgically correctable cause of hypertension, no standard criteria exist to classify surgical outcomes. The Primary Aldosteronism Surgical Outcome (PASO) study was an international project to develop consensus criteria for outcomes and follow-up of adrenalectomy for unilateral PA.

Objetives: To determine the proportions of patients achieving complete, partial, or absent clinical and biochemical success in accordance with the consensus criteria and to identify preoperative factors associated with outcomes in surgically treated patients with PA in three centers from Castilla La Mancha (Spain).

Design: Multicentric retrospective observational study.

Methods: We analysed clinical data from 53 patients with a diagnosis of unilateral PA who underwent surgery between 1999 and 2016, of whom 41 had postsurgical biochemical data. Treatment was guided by computed tomography (CT) scans. Preoperative adrenal vein sampling (AVS) was performed in 15 patients. We used the PASO standardised outcomes criteria (complete, partial, and absent success of clinical and biochemical outcomes) based on blood pressure, use of antihypertensive drugs (ADs), plasma potassium and aldosterone concentrations.

Results: Fifty three patients (30 male / 23 female); aged 52.4±11.2 years were studied. Mean postsurgical follow-up was 44.6 months (range 0-240). Complete clinical success and partial clinical success were achieved in 27 (50.9%) and 19 (35.8%) patients, respectively. In patients with postsurgical biochemical data, complete biochemical success and partial biochemical success were seen in 29 (70%) and 5 (12%), respectively. In univariate analysis, patients with complete clinical success were significantly younger than patients with partial or absent success (49.3±10 vs 56.8±10 vs 57.2±8.7 years) (P<0.01). Complete clinical success were more frequent in women (59.3% vs 26.3% vs 16.7%) (P<0.05). Number of preoperative ADs, level of preoperative arterial blood pressure or serum potassium levels did not differ significantly between patients with different outcomes. Using binary logistic regression analysis only female sex was independently associated with complete success (OR 6.5 CI 95% 1.2-36.9, P<0.05).

Conclusion: In our study, unilateral adrenalectomy for PA achieved complete or partial clinical and biochemical success in the majority of patients (86.7% and 82% respectively). Younger patients and female patients were more likely to have a favourable surgical outcome.