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Schematic diagram for adrenal venous sampling (AVS). The picture demonstrates left A/C ratio is 15.6 and right A/C ratio is 2.4. Left side divide to right side is 15.6/2.4 Z 6.5. Thus, aldosterone secretion is significantly predominant at left side. Furthermore, the picture demonstrates right A/C ratio is 2.4 and peripheral A/C ratio is 3.2. In other words, right side presents a phenomenon of contralateral suppression. Therefore, the AVS shows left lateralization. (Unit: Aldosterone, ng/ dL; Cortisol, mg/dL. The arrowheads mean catheterization into bilateral adrenal veins. Abbreviations: A/C, Aldosterone/ Cortisol; Kid, Kidney; Ad, Adrenal gland; T, tumor).
Source publication
Background/purpose:
Even though the increasing clinical recognition of primary aldosteronism (PA) as a public health issue, its heightened risk profiles and the availability of targeted surgical/medical treatment being more understood, consensus in its diagnosis and management based on medical evidence, while recognizing the constraints of our rea...
Context in source publication
Context 1
... adrenal nodule shown in image studies. 64 AVS is also not indicated in patients with proven FH-I or FH-III. 36,65 Specific anti-hypertensive medications (as mentioned earlier) are to be held for at least 21 days prior to the confirmatory AVS test. Patients with markedly high blood pressure are given diltiazem and/or doxazosin, if required (Fig. 1). 66 AVS paly the most critical role to help clinicians make a decision for surgery, especially in patients with bilateral adrenal adenomas, and patients with positive ARR but negative CT finding which potentially harboring small-sized unilateral adrenal adenoma. Furthermore, in APA patients with inconclusive NP-59 SPECT/CT, there would ...
Citations
... Primary hyperaldosteronism is a common cause of secondary hypertension and is associated with hypokalemia. 1,2 Compared to essential hypertension, primary hyperaldosteronism is associated with a higher risk of cardiovascular events and adverse effects in different target organs. These effects encompass organ fibrosis, 3 cardiovascular diseases, 4 osteoporosis, 5 metabolic syndrome, new-onset diabetes mellitus, 6 anxiety, 7 and obstructive sleep apnea. ...
... Surgical adrenalectomy is the recommended treatment for lateralized primary hyperaldosteronism. 1,2 Chen et al. 14 reported that the adrenalectomy group had a lower risk for mortality [odds ratio (OR) = 0.33, 95% confidence interval (CI): 0.15-0.73] and cardiovascular events (OR = 0.55, 95% CI: 0.40-0.74) ...
... For patients with bilateral adrenal hyperplasia or who are not eligible for surgery, mineralocorticoid receptor antagonists (MRAs) are commonly used to improve hypertension and correct hypokalemia. Recent guidelines 1,2,15,16 have recommended spironolactone as the first-line medical treatment, based on early randomized controlled trial (RCT) evidence. 17 However, some other RCTs have not shown significant differences in blood pressure control between spironolactone and eplerenone. ...
Background
The effectiveness and side effects between different medical treatments in patients with primary hyperaldosteronism have not been systematically studied.
Objective
To analyze the efficacy between different mineralocorticoid receptor antagonists (MRAs) and epithelial sodium channel (ENaC) inhibitors in a network meta-analysis (NMA) framework, while also evaluating adverse events.
Design
Systematic review and NMA.
Data sources and methods
The systematic review and NMA was reported according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, MEDLINE, the Cochrane library, and Excerpta Medica database (EMBASE) were searched for randomized controlled trials (RCTs) involving adult patients with primary hyperaldosteronism until 23 June 2023. Studies that compared the efficacy and side effects of different medical treatments of primary hyperaldosteronism were included. The primary outcomes included the effect on blood pressure, serum potassium, and major adverse cardiovascular events. The secondary outcomes were adverse events related to MRAs (hyperkalemia and gynecomastia). Frequentist NMA and pairwise meta-analysis were conducted.
Results
A total of 5 RCTs comprising 392 participants were included. Eplerenone, esaxerenone, and amiloride were compared to spironolactone and demonstrated comparable effect on the reduction of systolic blood pressure. In comparison to spironolactone, eplerenone exhibited a less pronounced effect on reducing diastolic blood pressure [−4.63 mmHg; 95% confidence interval (CI): −8.87 to −0.40 mmHg] and correcting serum potassium (−0.2 mg/dL; 95% CI: −0.37 to −0.03 mg/dL). Spironolactone presented a higher risk of gynecomastia compared with eplerenone (relative risk: 4.69; 95% CI: 3.58–6.14).
Conclusion
The present NMA indicated that the blood pressure reduction and potassium-correcting effects of the three MRAs may demonstrate marginal differences, with confidence levels in the evidence being very low. Therefore, further research is needed to explore the efficacy of these MRAs, especially regarding their impact on mortality and cardiovascular outcomes.
Trial registration
PROSPERO (CRD: 42023446811).
... The diagnosis of PA was confirmed according to the following three criteria 16 ...
Background
Primary aldosteronism (PA) has been associated with atherosclerosis beyond the extent of essential hypertension, but the impact of albuminuria remains unknown.
Objective
To investigate the effect of concomitant albuminuria on arterial stiffness in PA.
Design
Prospective cohort study.
Methods
A prospective cohort study was conducted to evaluate the association of albuminuria (>30 mg/g in morning spot urine) with arterial stiffness, as measured non-invasively by pulse wave velocity (PWV) in patients with PA. Propensity score matching (PSM) with age, sex, diabetes, systolic and diastolic blood pressure, creatinine, potassium, number of antihypertensive medications, and hypertension history was used to balance baseline characteristics. The effects of albuminuria on PWV before and 1 year after treatment were analyzed.
Results
A total of 840 patients with PA were enrolled, of whom 243 had concomitant albuminuria. After PSM, there were no significant differences in baseline demographic parameters except alpha-blocker and spironolactone use. PWV was greater in the presence of albuminuria ( p = 0.012) and positively correlated with urine albumin–creatinine ratio. Multivariable regression analysis identified albuminuria, age, body weight, systolic blood pressure, and calcium channel blocker use as independent predictors of PWV. As for treatment response, only PA patients with albuminuria showed significant improvements in PWV after PSM ( p = 0.001). The magnitude of improvement in PWV increased with urine albumin–creatinine ratio and reached plateau when it exceeded 100 mg/g according to restricted cubic spline analysis.
Conclusion
Concomitant albuminuria in PA was associated with greater arterial stiffness and more substantial improvement after targeted treatment. Both the baseline and the improved extent of PWV increased in correlation with rising urine albumin–creatinine ratio levels, reaching a plateau when the urine albumin–creatinine ratio surpassed 100 mg/g.
... For example, in the Japan Endocrine Society guidelines for PA management, dexamethasonesuppression 131I-adosterol scintigraphy is included in the imaging studies section as a valid procedure [25]. In addition, the Taiwan Society of Aldosteronism suggests NP-59 adrenal scintigraphy for functioning tumor lateralization for lesions larger than 1 cm [26]. Nevertheless, in most European countries and in EEUU, AVS is still considered the first-line technique for PA subtyping. ...
Purpose:
To evaluate the diagnostic accuracy of the 131I-6β-iodomethyl-19-norcholesterol (NP-59) adrenal scintigraphy for the subtyping diagnosis of primary aldosteronism (PA), considering as gold standard for the diagnosis of unilateral PA (UPA), either the results of the adrenal venous sampling (AVS) or the outcome after adrenalectomy.
Methods:
A retrospective multicenter study was performed on PA patients from 14 Spanish tertiary hospitals who underwent NP-59 scintigraphy with an available subtyping diagnosis. Patients were classified as UPA if biochemical cure was achieved after adrenalectomy or/and if an AVS lateralization index > 4 with ACTH stimulation or >2 without ACTH stimulation was observed. Patients were classified as having bilateral PA (BPA) if the AVS lateralization index was ≤4 with ACTH or ≤2 without ACTH stimulation or if there was evidence of bilateral adrenal nodules >1 cm in each adrenal gland detected by CT/MRI.
Results:
A total of 86 patients with PA were included (70.9% (n = 61) with UPA and 29.1% (n = 25) with BPA). Based on the NP-59 scintigraphy results, 16 patients showed normal suppressed adrenal gland uptake, and in the other 70 cases, PA was considered unilateral in 49 patients (70%) and bilateral in 21 (30%). Based on 59-scintigraphy results, 10.4% of the patients with unilateral uptake had BPA, and 27.3% of the cases with bilateral uptake had UPA. The AUC of the ROC curve of the NP-59 scintigraphy for PA subtyping was 0.812 [0.707-0.916]. Based on the results of the CT/MRI and NP-59 scintigraphy, only 6.7% of the patients with unilateral uptake had BPA, and 24% of the cases with bilateral uptake had UPA. The AUC of the ROC curve of the model combining CT/MRI and 59-scintigraphy results for subtyping PA was 0.869 [0.782-0.957].
Conclusion:
The results of NP-59 scintigraphy in association with the information provided by the CT/MRI may be useful for PA subtyping. However, their diagnostic accuracy is only moderate. Therefore, it should be considered a second-line diagnostic tool when AVS is not an option.
... We retrospectively enrolled 80 patients with clinically suspected PA who underwent AVS between May 2020 and May 2021 and were followed up until February 2022 at National Taiwan University Hospital. We used prospectively collected data from the Taiwan Primary Aldosteronism Investigators (TAIPAI) database to standardize data collection [4]. Five patients were excluded from the study. ...
... PA screening, confirmation, and subtype differentiation were performed in accordance with the aforementioned TAIPAI protocol [4]. In brief, we used the plasma aldosterone concentration (PAC)/plasma renin activity (PRA) ratio (ARR) to detect possible cases of PA. ...
Adrenal venous sampling (AVS) is the gold standard for identifying curable unilateral aldosterone excess in primary aldosteronism (PA). Studies have demonstrated the value of steroid profiling through liquid chromatography–tandem mass spectrometry (LC–MS/MS) in AVS interpretation. First, the performance of LC–MS/MS and immunoassay in assessing selectivity and lateralization was compared. Second, the utility of the proportion of individual steroids in adrenal veins in subtyping PA was analyzed. We enrolled 75 consecutive patients with PA who underwent AVS between 2020 and 2021. Fifteen adrenal steroids were analyzed in peripheral and adrenal veins through LC–MS/MS before and after adrenocorticotropic hormone (ACTH) stimulation. Through selectivity index that was based on cortisol and alternative steroids, LC–MS/MS rescued 45% and 66% of failed cases judged by immunoassay in unstimulated and stimulated AVS, respectively. LC–MS/MS identified more unilateral diseases than did immunoassay (76% vs. 45%, P < 0.05) and provided adrenalectomy opportunities to 69% of patients judged through immunoassay to have bilateral disease. The secretion ratios (individual steroid concentration/total steroid concentration) of aldosterone, 18-oxocortisol, and 18-hydroxycortisol were novel indicators for identifying unilateral PA. The 18-oxocortisol secretion ratio of ≥0.785‰ (sensitivity/specificity: 0.90/0.77) at pre-ACTH and aldosterone secretion ratio of ≤0.637‰ (sensitivity/specificity: 0.88/0.85) at post-ACTH enabled optimal accuracy for predicting ipsilateral and contralateral disease, respectively, in robust unilateral PA. LC–MS/MS improved the success rate of AVS and identified more unilateral diseases than immunoassay. The secretion ratios of steroids can be used to discriminate the broad PA spectrum.
... The aldosterone-to-renin ratio (ARR) is widely used as the screening method for primary aldosteronism (PA). 1 However, many clinical factors as well as antihypertensive medications may affect plasma renin activity (PRA) and/or plasma aldosterone concentration (PAC), thereby substantially interfering with the interpretation of the ARR. 2,3 Although holding all anti-hypertensive medications before screening for PA using the ARR has been recommended, this may be impractical and unsafe and could predispose patients to hypertensive crisis. ...
KEYWORDS Primary aldosteronism; Aldosterone-to-renin ratio; Anti-hypertensive medications; a-adrenergic receptor blocking agents; Centrally acting a-adrenergic agonists; Nondihydropyridine calcium channel blockers Anti-hypertensive medications may affect plasma renin activity and/or plasma aldosterone concentration, misleading the interpretation of the aldosterone-to-renin ratio when screening for primary aldosteronism. The Task Force of Taiwan PA recommends that, when necessary, using a-adrenergic receptor blocking agents, centrally acting a-adrenergic agonists, and/or non-dihydropyridine calcium channel blockers should be considered to control blood pressure before screening for PA. We recommend temporarily holding b-adrenergic receptor blocking agents, mineralocorticoid receptor antagonists, dihydropyridine calcium channel blockers, angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, and all diuretics before screening for PA. Further large-scale randomized controlled studies are required to confirm the recommendations.
... The diagnosis and subtype of PA were established in hypertensive patients as follows. PA was diagnosed based on ful lling the following three conditions [11,12]: (1) autonomous excess aldosterone production as indicated by an aldosterone-renin ratio (ARR) greater than 35 (ng/dL)/(ng/mL/h); (2) a TAIPAI score > 60% [13]; (3) plasma aldosterone concentration (PAC) > 16 ng/dL [14] post-saline loading test, or ARR > 35 (ng/dL)/(ng/mL/h) after a captopril or losartan test [15]. ...
... We used a criteria of autonomous excess aldosterone production evidenced with ARR > 35 ng/dL per ng/ml/hr after captopril test, TAIPAI score > 60% # The probability of PA (TAIPAI score) was equal to: The following criteria were used to diagnose unilateral primary aldosteronism (uPA) [15] : (1) the presence of an adrenal nodule or thickening observed through a computer tomography scan. (2); lateralization of aldosterone over-secretion in adrenal vein sampling(3); classical aldosterone-producing adenoma, which was con rmed through pathological analysis. ...
Background
Serum cortisol level after 1-mg overnight dexamethasone suppression test (1-mg DST) below 1.8 ug/dL was a diagnostic criterion for having autonomous cortisol secretion (ACS), whether the cut-off point in 24-hour urine-free cortisol (24-h UFC) for the patient suspecting with primary aldosteronism (PA) concomitant ACS is unclear.
Methods
This prospective observational study enrolled 274 patients diagnosed with PA from January 2017 to January 2020 (male, 42.3%; mean age, 55.9 ± 11.7 years). Serum cortisol level after 1 mg DST over 1.8 ug/dL was a diagnostic criterion for ACS, confirmed with a second repeated test.
Results
Of the 274 PA patients, 74 patients (27%) with PA had concomitant ACS while the other 200 patients were not. Logistic regression analysis showed patients with PA concomitant ACS were associated with higher 24-h UFC (OR, 1.91 [95% CI, 1.06–3.41], P=0.03), older age (OR, 1.04 [95% CI, 1.01–1.07], P=0.008), and diabetes mellitus (OR, 2.4 [95% CI, 1.12–5.12], P=0.025). The generalized additive model (GAM) for urinary cortisol and ACS showed the 24-h UFC above 36 μg, concurrent with the positive predictive value of 32.6% and negative predictive value of 77.9% could be a factor predicting a higher possibility of ACS.
Conclusions
More than a quarter of PA patients concomitant ACS. Our study suggested the 24-h UFC less than 36 μg as a cut-off point in exclusion of the patient with PA concomitant ACS. Additionally, older age and diabetes mellitus were also risk factors for predicting patients with PA concomitant ACS.
... Screening, confirmation, and subtype identification of incident PA were performed in the referred patients with hypertension according to the standard TAIPAI protocol and aldosteronism consensus in Taiwan. 16 All original antihypertensive medications were discontinued for at least 21 days before PA screening and confirmatory tests. Doxazosin or diltiazem were administered to control markedly high blood pressure (BP) during the workup stage when required. ...
... Fulfillment of the following 3 criteria confirmed the diagnosis of PA: (1) autonomous excess aldosterone production with an aldosterone-renin ratio (plasma aldosterone concentration [PAC]/plasma renin activity [PRA]) >35 (ng/dL)/(ng/mL/h); (2) a TAIPAI score >60%; 19 or (3) postsaline loading PAC >16 ng/dL, or PAC/PRA >35 (ng/dL)/(ng/mL/h) shown in a postcaptopril/losartan test. 16 The uPA was further identified on the basis of the following criteria during the study period: 20,21 (1) lateralization of aldosterone hypersecretion via adrenal vein sampling or during dexamethasone suppression NP-59 single-photon emission computed tomography/computed tomography; and (2 only for uPA after adrenalectomy) pathologically proven positive CYP11B2-staining adenoma or (multiple) aldosteroneproducing micronodules via immunohistochemistry. 20,22 Otherwise, the patients with PA were defined as having biPA. ...
Background Targeted treatment with mineralocorticoid receptor antagonists (MRAs) or adrenalectomy in patients with primary aldosteronism (PA) causes a decline in estimated glomerular filtration rate; however, the associated simultaneous changes in biomarkers of kidney tubule health still remain unclear. Methods and Results We matched 104 patients with newly diagnosed unilateral PA who underwent adrenalectomy with 104 patients with unilateral PA who were treated with MRAs, 104 patients with bilateral PA treated with MRAs, and 104 patients with essential hypertension who served as controls. Functional biomarkers were measured before the targeted treatment and 1 year after treatment, including serum markers of kidney function (cystatin C, creatinine), urinary markers of proximal renal tubular damage (L‐FABP [liver‐type fatty‐acid binding protein], KIM‐1 [kidney injury molecule‐1]), serum markers of kidney tubular reserve and mineral metabolism (intact parathyroid hormone), and proteinuria. Compared with the patients with essential hypertension, the patients with PA had higher pretreatment serum intact parathyroid hormone and urinary creatinine‐corrected parameters, including L‐FABP, KIM‐1, and albumin. The patients with essential hypertension and with PA had similar cystatin C levels. After treatment with MRAs or adrenalectomy of unilateral PA and MRAs of bilateral PA, the patients with PA had increased serum cystatin C and decreased urinary L‐FABP/creatinine, KIM‐1/creatinine, creatinine‐based estimated glomerular filtration rate, intact parathyroid hormone, and proteinuria (all P
... These individuals were registered in the Taiwan Primary Aldosteronism Investigation (TAIPAI) database. 8,9 Individuals with secondary hypertension due to other etiologies, including pheochromocytoma, Cushing's syndrome, hyperthyroidism, and renovascular causes, were excluded. The demographic characteristics, and laboratory and echocardiographic parameters were manually recorded and reviewed. ...
Background
Primary aldosteronism (PA) is the leading cause of secondary hypertension globally and is associated with adverse cardiovascular outcomes. However, the cardiac impact of concomitant albuminuria remains unknown.
Objective
To compare anatomical and functional remodeling of left ventricle (LV) in PA patients with or without albuminuria.
Design
Prospective cohort study.
Methods
The cohort was separated into two arms according to the presence or absence of albuminuria (>30 mg/g of morning spot urine). Propensity score matching with age, sex, systolic blood pressure, and diabetes mellitus was performed. Multivariate analysis was conducted with adjustments for age, sex, body mass index, systolic blood pressure, duration of hypertension, smoking, diabetes mellitus, number of antihypertensive agents, and aldosterone level. A local-linear model with bandwidth of 2.07 was used to study correlations.
Results
A total of 519 individuals with PA were enrolled in the study, of whom 152 had albuminuria. After matching, the albuminuria group had a higher creatinine level, at baseline. With regard to LV remodeling, albuminuria was independently associated with a significantly higher interventricular septum (1.22 > 1.17 cm, p = 0.030), LV posterior wall thickness (1.16 > 1.10 cm, p = 0.011), LV mass index (125 > 116 g/m ² , p = 0.023), and medial E/e′ ratio (13.61 > 12.30, p = 0.032), and a lower medial early diastolic peak velocity (5.70 < 6.36 cm/s, p = 0.016). Multivariate analysis further revealed that albuminuria was an independent risk factor for elevated LV mass index ( p < 0.001) and medial E/e′ ratio ( p = 0.010). Non-parametric kernel regression also demonstrated that the level of albuminuria was positively correlated with LV mass index. The remodeling of LV mass and diastolic function under the presence of albuminuria distinctly improved after PA treatment.
Conclusion
The presence of concomitant albuminuria in patients with PA was associated with pronounced LV hypertrophy and compromised LV diastolic function. These alterations were reversible after treatment for PA.
Plain language summary
Cardiac Impact of Primary Aldosteronism and Albuminuria Primary aldosteronism and albuminuria has been, respectively, demonstrated to bring about left ventricular remodeling, but the aggregative effect was unknown. We constructed a prospective single-center cohort study in Taiwan. We proposed the presence of concomitant albuminuria was associated with left ventricular hypertrophy and compromised diastolic function. Intriguingly, management of primary aldosteronism was able to restore these alterations. Our study delineated the cardiorenal crosstalk in the setting of secondary hypertension and the role of albuminuria for left ventricular remodeling. Future interrogations toward the underlying pathophysiology as well as therapeutics will facilitate the improvement of holistic care for such population.
... According to previously published protocols and algorithms, 21,22 the patients who met the following criteria were diagnosed with PA: (1) autonomous excess aldosterone production with an aldosterone-to-renin ratio (ARR) > 35, (2) a TAIPAI score > 60%, and (3) post-saline loading plasma aldosterone concentration (PAC) > 10 ng/ dL, or ARR > 35 (ng/dL)/(ng/mL-h) in a postcaptopril test, or PAC > 6 ng/dL in a fludrocortisone suppression test. ...
... A diagnosis of APA in the PA patients was based on the following criteria: (1) adenoma on a preoperative computed tomography (CT) scan, (2) lateralization of aldosterone secretion confirmed by adrenal vein sampling or dexamethasone suppression NP-59 single photon emission computed tomography (SPECT)/CT, or (3) pathologically proven adenoma after adrenalectomy/cure of hypertension or improvement in hypertension, biological parameters after adrenalectomy. 22 A diagnosis of idiopathic adrenal hyperplasia (IHA) PA patients was based on the following criteria: (1) bilateral diffuse enlargement of adrenal glands on a CT scan, (2) non-lateralization of aldosterone secretion in adrenal vein sampling or during a dexamethasone suppression NP-59 SPECT/CT, or (3) pathologically reported diffuse cell hyperplasia for those who underwent adrenalectomy. 22 ...
... 22 A diagnosis of idiopathic adrenal hyperplasia (IHA) PA patients was based on the following criteria: (1) bilateral diffuse enlargement of adrenal glands on a CT scan, (2) non-lateralization of aldosterone secretion in adrenal vein sampling or during a dexamethasone suppression NP-59 SPECT/CT, or (3) pathologically reported diffuse cell hyperplasia for those who underwent adrenalectomy. 22 ...
Background
Elevated arterial stiffness in patients with primary aldosteronism (PA) can be reversed after adrenalectomy; however, the effect of medical treatment with mineralocorticoid receptor antagonist (MRAs) is unknown.
Objectives
The aim of this study was to evaluate the effect of MRAs and compare both treatment strategies on arterial stiffness in PA patients.
Design
Prospective cohort study.
Methods
We prospectively enrolled PA patients from 2006 to 2019 who received either adrenalectomy or MRA treatment (spironolactone). We compared their baseline and 1-year post-treatment biochemistry characteristics and arterial pulse wave velocity (PWV) to verify the effects of treatment and related determinant factors.
Results
A total 459 PA patients were enrolled. After 1:1 propensity score matching for age, sex and blood pressure (BP), each group had 176 patients. The major determinant factors of baseline PWV were age and baseline BP. The adrenalectomy group had greater improvements in BP, serum potassium level, plasma aldosterone concentration, and aldosterone-to-renin ratio. The MRA group had a significant improvement in PWV after 1 year of treatment (1706.2 ± 340.05 to 1613.6 ± 349.51 cm/s, p < 0.001). There were no significant differences in post-treatment PWV ( p = 0.173) and improvement in PWV ( p = 0.579) between the adrenalectomy and MRA groups. The determinant factors for an improvement in PWV after treatment were hypertension duration, baseline PWV, and the decrease in BP.
Conclusion
The PA patients who received medical treatment with MRAs had a significant improvement in arterial stiffness. There was no significant difference in the improvement in arterial stiffness between the two treatment strategies.
... Diltiazem and/or doxazosin were prescribed for BP control if required. The diagnosis of unilateral PA was made in the patients who fulfilled at least 1 of the following 3 conditions: (1) adenoma on a computed tomography (CT) scan in preoperative evaluation; (2) lateralization of aldosterone secretion confirmed by adrenal vein sampling or dexamethasone suppression NP-59 single photon emission computed tomography (SPECT)/CT; (3) pathologically proven adenoma if receiving adrenalectomy (34). Bilateral PA was identified in patients according to the following 3 conditions: (1) bilateral diffuse enlargement of adrenal glands on CT scan; (2) nonlateralization of aldosterone secretion by adrenal vein sampling or dexamethasone suppression NP-59 SPECT/CT; (3) pathologically reported diffuse cell hyperplasia for the patients receiving adrenalectomy (34). ...
... The diagnosis of unilateral PA was made in the patients who fulfilled at least 1 of the following 3 conditions: (1) adenoma on a computed tomography (CT) scan in preoperative evaluation; (2) lateralization of aldosterone secretion confirmed by adrenal vein sampling or dexamethasone suppression NP-59 single photon emission computed tomography (SPECT)/CT; (3) pathologically proven adenoma if receiving adrenalectomy (34). Bilateral PA was identified in patients according to the following 3 conditions: (1) bilateral diffuse enlargement of adrenal glands on CT scan; (2) nonlateralization of aldosterone secretion by adrenal vein sampling or dexamethasone suppression NP-59 SPECT/CT; (3) pathologically reported diffuse cell hyperplasia for the patients receiving adrenalectomy (34). The choice between unilateral adrenalectomy and medical treatment with MRAs was made after discussion with the unilateral PA patients in addition to a preoperative assessment. ...
Context
Primary aldosteronism (PA) patients have a higher degree of arterial stiffness which can be reversed after adrenalectomy.
Objective
We aimed to compare the reversal of arterial stiffness between surgically and medically treated PA patients and to identify the predictors of effective medical treatment.
Methods
We prospectively enrolled 445 PA patients and collected data on baseline clinical characteristics, biochemistry, blood pressure, and pulse wave velocity (PWV) before treatment and 12 months after treatment. In the mineralocorticoid receptor antagonists (MRAs)-treated patients, the relationship between the change in PWV after 1 year (ΔPWV) and post-treatment renin activity was explored using the restricted cubic spline (RCS) method.
Results
Of the 445 enrolled PA patients, 255 received adrenalectomy (group 1) and 190 received MRAs. In the RCS model, post-treatment plasma renin activity (PRA) 1.5 ng/mL/h was the best cut-off value. Therefore, we divided the MRA-treated patients into two group: those with suppressed PRA (< 1.5 ng/mL/h, group 2), and those with unsuppressed PRA (>= 1.5 ng/mL/h, group 3).
Only group 1 and group 3 patients had a significant improvement in PWV after treatment (both P < 0.001), whereas no significant improvement was noted in group 2 after treatment (P = 0.151). In ANOVA and post-hoc analysis, group 2 had a significantly lower ΔPWV than group 1 (P = 0.007) and group 3 (P = 0.031). Multivariable regression analysis of the MRA-treated PA patients identified log-transformed post-treatment PRA, age, and baseline PWV as independent factors correlated with ΔPWV.
Conclusions
The reversal of arterial stiffness was found in PA patients receiving adrenalectomy and in medically treated PA patients with unsuppressed PRA.
