Surgical treatment outcome of primary aldosteronism assessed using new modified diagnostic tests

Purpose Primary aldosteronism (PA) is the most frequent type of endocrine hypertension. In our previous studies, we introduced two modified diagnostic tests for PA, the post-dexamethasone saline infusion test (DSIT) and the overnight dexamethasone, captopril, and valsartan test (DCVT). In this study...

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Published in:Hormones (Athens, Greece) Greece), 2021-06, Vol.20 (2), p.359-368
Main Authors: Alexandraki, Krystallenia I., Markou, Athina, Papanastasiou, Labrini, Tyfoxylou, Ernestini, Kapsali, Chara, Gravvanis, Christos, Katsiveli, Pinelopi, Kaltsas, Gregory A., Zografos, George N., Chrousos, George P., Piaditis, George
Format: Article
Language:English
Subjects:
Adenoma
Captopril
Dexamethasone
Diagnostic Tests, Routine
Dichlorodiphenyldichloroethane
Endocrinology
Humans
Hyperaldosteronism - diagnosis
Hyperaldosteronism - surgery
Hypertension - diagnosis
Hypertension - drug therapy
Medicine
Medicine & Public Health
Metabolic Diseases
Original Article
Retrospective Studies
Treatment Outcome
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Summary:Purpose Primary aldosteronism (PA) is the most frequent type of endocrine hypertension. In our previous studies, we introduced two modified diagnostic tests for PA, the post-dexamethasone saline infusion test (DSIT) and the overnight dexamethasone, captopril, and valsartan test (DCVT). In this study, we aimed to validate both tests in respect to the biochemical and clinical response of a cohort of hypertensive patients in pre- and post-surgical setting. Methods We retrospectively studied 41 hypertensive patients (16 males), with a median (IQR, range) age of 50 (16, 35–74) years and positive histology for adrenal adenoma. Preoperatively, all patients had a single adenoma on CT and a diagnosis of PA with either DSIT or DCVT. The defined daily dose (DDD) of hypertensive drugs was assessed pre- and postoperatively. DSIT or DCVT and basal ARR were reassessed postoperatively. Results Two of the 41 patients failed to suppress aldosterone post-surgery, leading to a post-adrenalectomy biochemical cure rate of 95%, while blood pressure was improved in 36 patients, leading to a clinical cure rate of 88% as assessed by the DDD methodology. Conclusions The present study was a proof-of-concept process to validate two modified diagnostic tests for PA in clinical practice. These tests, used to diagnose a group of patients with PA, successfully assessed their biochemical cure post-adrenalectomy at rates similar to those reported in the literature.
ISSN:1109-3099
2520-8721
DOI:10.1007/s42000-021-00280-8