Immunohistopathology and Steroid Profiles Associated With Biochemical Outcomes After Adrenalectomy for Unilateral Primary Aldosteronism

Unilateral primary aldosteronism (PA) is the most common surgically curable form of hypertension that must be accurately differentiated from bilateral PA for therapeutic management (surgical versus medical). Adrenalectomy results in biochemical cure (complete biochemical success) in almost all patie...

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Published in:Hypertension (Dallas, Tex. 1979) Tex. 1979), 2018-09, Vol.72 (3), p.650-657
Main Authors: Meyer, Lucie S, Wang, Xiao, Sušnik, Eva, Burrello, Jacopo, Burrello, Alessio, Castellano, Isabella, Eisenhofer, Graeme, Fallo, Francesco, Kline, Gregory A, Knösel, Thomas, Kocjan, Tomaz, Lenders, Jacques W.M, Mulatero, Paolo, Naruse, Mitsuhide, Nishikawa, Tetsuo, Peitzsch, Mirko, Rump, Lars C, Beuschlein, Felix, Hahner, Stefanie, Gomez-Sanchez, Celso E, Reincke, Martin, Williams, Tracy Ann
Format: Article
Language:English
Subjects:
Adrenal Glands - metabolism
Adrenal Glands - pathology
Adrenal Glands - surgery
Adrenalectomy - methods
Adult
Aldosterone - blood
Cytochrome P-450 CYP11B2 - metabolism
Female
Humans
Hyperaldosteronism - blood
Hyperaldosteronism - metabolism
Hyperaldosteronism - surgery
Immunohistochemistry
Male
Middle Aged
Outcome Assessment (Health Care) - methods
Outcome Assessment (Health Care) - statistics & numerical data
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Summary:Unilateral primary aldosteronism (PA) is the most common surgically curable form of hypertension that must be accurately differentiated from bilateral PA for therapeutic management (surgical versus medical). Adrenalectomy results in biochemical cure (complete biochemical success) in almost all patients diagnosed with unilateral PA; the remaining patients with partial or absent biochemical success comprise those with persisting aldosteronism who were misdiagnosed as unilateral PA preoperatively. To identify determinants of postsurgical biochemical outcomes, we compared the adrenal histopathology and the peripheral venous steroid profiles of patients with partial and absent or complete biochemical success after adrenalectomy for unilateral PA. A large multicenter cohort of adrenals from patients with absent and partial biochemical success (n=43) displayed a higher prevalence of hyperplasia (49% versus 21%; P=0.004) and a lower prevalence of solitary functional adenoma (44% versus 79%; P
ISSN:0194-911X
1524-4563
DOI:10.1161/HYPERTENSIONAHA.118.11465