Histopathological evaluation based on CYP11B2 staining predicts outcomes in unilateral primary aldosteronism

Area of Science:

• Endocrinology
• Pathology
• Surgical Oncology

Background:

• Histopathological classification using aldosterone synthase (CYP11B2) immunostaining in unilateral primary aldosteronism (PA) is controversial for predicting post-adrenalectomy outcomes.
• Understanding the prognostic value of different histological subtypes is crucial for managing PA.

Purpose of the Study:

• To evaluate the utility of histopathological classification (HISTALDO criteria) in predicting clinical and biochemical outcomes after unilateral adrenalectomy in patients with unilateral PA.
• To determine if the distinction between aldosterone-producing adenoma (APA) and aldosterone-producing nodule (APN) impacts patient outcomes.

Main Methods:

• A cohort study of 131 patients with unilateral PA undergoing unilateral adrenalectomy.
• Histopathological classification of adrenal lesions using HISTALDO criteria and assessment of outcomes via the PASO criteria.
• Multivariable analysis to identify independent predictors of success.

Main Results:

• Classical histology (77.09%) was associated with younger patients and higher rates of complete biochemical success (97.03%) and hypertension remission (34.34%) compared to non-classical histology (22.91%).
• Classical histology independently predicted better biochemical and clinical success post-adrenalectomy.
• No significant difference in clinical or biochemical outcomes was observed between aldosterone-producing adenoma (APA) and aldosterone-producing nodule (APN).

Conclusions:

• Classical histology is an independent predictor of improved biochemical and hypertension remission in surgically treated unilateral PA patients.
• The distinction between APA and APN does not appear to differentiate outcomes in this cohort.
• Histopathology provides valuable prognostic information for PA management.