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Unilateral Primary Aldosteronism: Long-Term Disease Recurrence After Adrenalectomy
Martina Tetti1, Denise Brüdgam1, Jacopo Burrello2
1Medizinische Klinik und Poliklinik IV, Ludwig-Maximilians-Universität Klinikum (M.T., D.B., A.R., F.B., M.R., T.A.W.), Ludwig-Maximilians-Universität München, Germany.
Hypertension (Dallas, Tex. : 1979)
|February 6, 2024
Summary
Biochemical recurrence of primary aldosteronism (PA) occurs in 23% of patients long-term after adrenalectomy, particularly those with nonclassical histopathology. Continued monitoring is crucial for surgically treated PA patients.
Area of Science:
- Endocrinology
- Surgical Oncology
- Pathology
Background:
- Primary aldosteronism (PA) often stems from unilateral aldosterone-producing adenomas with specific mutations.
- While unilateral adrenalectomy offers short-term remission, long-term postsurgical outcomes for PA remain poorly defined.
Purpose of the Study:
- To investigate the long-term incidence of PA recurrence in patients who achieved short-term biochemical remission after surgery.
Main Methods:
- Retrospective analysis of adrenalectomized patients with unilateral PA from a single center.
- Histopathology and outcomes assessed using international consensuses (Primary Aldosteronism Surgical Outcome - PASO).
- Genotyping performed via CYP11B2 sequencing.
Main Results:
- Classical histopathology (solitary adenoma) seen in 78% of cases.
- Short-term biochemical success (93%) decreased long-term, with 23% recurrence.
- Nonclassical histopathology was significantly associated with long-term PA recurrence (60% vs. 14%).
Conclusions:
- A significant portion of patients experience biochemical recurrence of PA post-surgery, linked to adrenal gland histopathology.
- Histopathology assessment and ongoing outcome monitoring are vital for managing surgically treated PA patients.
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