Primary aldosteronism and long-term outcomes using PAMO definition

Area of Science:

• Endocrinology
• Surgical Oncology
• Hypertension Management

Background:

• Primary aldosteronism is the leading cause of endocrine hypertension.
• Current management for bilateral primary aldosteronism relies on medical therapy, often with poor tolerance and limited cardiovascular outcome prevention.
• Mineralocorticoid receptor antagonists have suboptimal efficacy and tolerability.

Purpose of the Study:

• To evaluate the clinical and biochemical outcomes of adrenal surgery in patients with bilateral primary aldosteronism.
• To assess the safety and efficacy of both unilateral and bilateral adrenalectomy in this patient cohort.
• To challenge the traditional paradigm of exclusive medical management for bilateral primary aldosteronism.

Main Methods:

• International retrospective cohort study involving 56 patients with bilateral primary aldosteronism.
• Patients underwent unilateral or bilateral adrenal surgery based on adrenal venous sampling and CT findings.
• Clinical and biochemical outcomes were assessed at 6-12 months and beyond 12 months follow-up.

Main Results:

• High rates of clinical benefit (81% unilateral, 92% bilateral) and biochemical success (65% unilateral, 85% bilateral) were observed.
• Benefits persisted beyond 12 months post-surgery.
• Adrenal insufficiency occurred in 31% after bilateral surgery but was mostly transient; histopathology confirmed bilateral lesions.

Conclusions:

• Adrenal surgery, including in selected cases of bilateral primary aldosteronism, yields favorable clinical and biochemical outcomes.
• The safety profile of adrenal surgery in this context is acceptable.
• Surgical intervention presents a potential alternative to exclusive medical management for bilateral primary aldosteronism.