Key result
Normal basal aldosterone linked to ~3% lower odds of clinical success after adrenalectomy.
Why the study?
Differences in therapeutic outcomes between patients with primary aldosteronism presenting with normal basal plasma aldosterone concentration versus high basal plasma aldosterone concentration were unclear.
Does basal plasma aldosterone concentration predict therapeutic outcomes of adrenalectomy or MRAs in patients with primary aldosteronism?
Cohort (n=1,146)
Yes
Does basal plasma aldosterone concentration predict therapeutic outcomes of adrenalectomy or MRAs in patients with primary aldosteronism?
Baseline plasma aldosterone concentration can predict the clinical success of treatments for primary aldosteronism, suggesting MRAs may be preferable to adrenalectomy in patients with normal basal levels.
Normal basal PAC was associated with lower adrenalectomy but higher MRA success; leaves open whether PAC should guide treatment choice in primary aldosteronism.
PURPOSE: Normal basal plasma aldosterone concentration (PAC) reflects mild aldosterone excess compared to high basal PAC. We previously reported lower risk for cardiovascular and cerebrovascular events in patients with primary aldosteronism (PA) and normal basal PAC (nPA) than in those with high basal PAC (hPA). However, the differences in therapeutic outcomes between nPA and hPA are unclear. The aim of this multi-institutional, retrospective cohort study was to determine the clinical significance of nPA to therapeutic outcomes, including adrenalectomy (ADX) and treatment with mineralocorticoid receptor antagonists (MRAs). METHODS: A total of 1146 patients with PA who were diagnosed and underwent adrenal venous sampling (AVS) between January 2006 and October 2016 were enrolled. The clinical parameters at baseline and after ADX or treatment with MRA were compared between the nPA and hPA groups. Logistic regression analysis identified baseline PAC as a significant independent predictor of absent clinical success of ADX and MRAs. CONCLUSIONS: Plasma aldosterone concentration at baseline was a significant and independent predictor of absent clinical success of ADX and MRA. Mineralocorticoid receptor antagonist treatment appeared to be a better therapeutic choice than ADX in the nPA group.
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Saiki et al. (2020) conducted a cohort in Primary aldosteronism (n=1,146). Normal basal plasma aldosterone concentration (<16 ng/dL) vs. High basal plasma aldosterone concentration (>=16 ng/dL) was evaluated on Absent clinical success at 1 year after adrenalectomy (OR 0.97, 95% CI 0.96-0.99, p=<0.01). Normal basal plasma aldosterone concentration (<16 ng/dL) was associated with higher absent clinical success after adrenalectomy than high PAC (36.6% vs 21.9%, P=0.01), but better MRA success.
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