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Prognostic value of contralateral suppression for remission after surgery in patients with primary aldosteronism

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@article{aa1199a2b85448859bd8c064bfc37250,
title = "Prognostic value of contralateral suppression for remission after surgery in patients with primary aldosteronism",
abstract = "OBJECTIVE: Primary aldosteronism (PA) is the most common cause of endocrine hypertension and adrenalectomy is the firstline treatment for unilateral PA. Suppression of aldosterone secretion of the nondominant adrenal gland at adrenal venous sampling (AVS), that is, contralateral suppression (CLS) has been suggested as a marker of disease severity. However, whether factors such as CLS, age, gender or comorbidities are associated with remission after surgery is controversial. The objective of this study is to investigate the prognostic value of CLS, age, gender, aldosterone-to-renin ratio, antihypertensives and comorbidities for clinical and biochemical remission following unilateral adrenalectomy in patients with PA.DESIGN AND PATIENTS: A retrospective study of patients with PA referred for AVS at Rigshospitalet from May 2011 to September 2020, who subsequently underwent adrenalectomy. Clinical remission was defined according to the PA surgical outcome criteria, whereas complete biochemical remission was defined as normalization of hypokalaemia without potassium substitution.RESULTS: Eighty-four patients were available for analysis of primary outcome. Among patients with CLS, 28/58 (48.3%) obtained complete clinical remission after surgery compared with 10/26 (38.5%) without CLS (p = .40). Complete biochemical remission was obtained in 55/58 (94.8%) of patients with CLS compared with 25/28 (89.3%) without CLS (p = .44). Female gender and lower number of antihypertensives at baseline were associated with higher odds for complete clinical remission, whereas none of the investigated variables were associated with biochemical remission.CONCLUSION: CLS was not significantly associated with complete clinical or biochemical remission in this cohort. Our results confirmed that female gender and lower number of antihypertensives were predictors of clinical remission.",
keywords = "Adrenal Glands, Adrenalectomy/methods, Aldosterone, Antihypertensive Agents, Female, Humans, Hyperaldosteronism/drug therapy, Prognosis, Retrospective Studies",
author = "Sara M{\o}rup and Nathalie Voss and Caroline Clausen and Feltoft, {Claus Larsen} and Mikkel Andreassen and Jesper Krogh",
note = "{\textcopyright} 2022 John Wiley & Sons Ltd.",
year = "2022",
month = jun,
doi = "10.1111/cen.14678",
language = "English",
volume = "96",
pages = "793--802",
journal = "Clinical Endocrinology",
issn = "0300-0664",
publisher = "Wiley-Blackwell Publishing Ltd",
number = "6",

}

RIS

TY - JOUR

T1 - Prognostic value of contralateral suppression for remission after surgery in patients with primary aldosteronism

AU - Mørup, Sara

AU - Voss, Nathalie

AU - Clausen, Caroline

AU - Feltoft, Claus Larsen

AU - Andreassen, Mikkel

AU - Krogh, Jesper

N1 - © 2022 John Wiley & Sons Ltd.

PY - 2022/6

Y1 - 2022/6

N2 - OBJECTIVE: Primary aldosteronism (PA) is the most common cause of endocrine hypertension and adrenalectomy is the firstline treatment for unilateral PA. Suppression of aldosterone secretion of the nondominant adrenal gland at adrenal venous sampling (AVS), that is, contralateral suppression (CLS) has been suggested as a marker of disease severity. However, whether factors such as CLS, age, gender or comorbidities are associated with remission after surgery is controversial. The objective of this study is to investigate the prognostic value of CLS, age, gender, aldosterone-to-renin ratio, antihypertensives and comorbidities for clinical and biochemical remission following unilateral adrenalectomy in patients with PA.DESIGN AND PATIENTS: A retrospective study of patients with PA referred for AVS at Rigshospitalet from May 2011 to September 2020, who subsequently underwent adrenalectomy. Clinical remission was defined according to the PA surgical outcome criteria, whereas complete biochemical remission was defined as normalization of hypokalaemia without potassium substitution.RESULTS: Eighty-four patients were available for analysis of primary outcome. Among patients with CLS, 28/58 (48.3%) obtained complete clinical remission after surgery compared with 10/26 (38.5%) without CLS (p = .40). Complete biochemical remission was obtained in 55/58 (94.8%) of patients with CLS compared with 25/28 (89.3%) without CLS (p = .44). Female gender and lower number of antihypertensives at baseline were associated with higher odds for complete clinical remission, whereas none of the investigated variables were associated with biochemical remission.CONCLUSION: CLS was not significantly associated with complete clinical or biochemical remission in this cohort. Our results confirmed that female gender and lower number of antihypertensives were predictors of clinical remission.

AB - OBJECTIVE: Primary aldosteronism (PA) is the most common cause of endocrine hypertension and adrenalectomy is the firstline treatment for unilateral PA. Suppression of aldosterone secretion of the nondominant adrenal gland at adrenal venous sampling (AVS), that is, contralateral suppression (CLS) has been suggested as a marker of disease severity. However, whether factors such as CLS, age, gender or comorbidities are associated with remission after surgery is controversial. The objective of this study is to investigate the prognostic value of CLS, age, gender, aldosterone-to-renin ratio, antihypertensives and comorbidities for clinical and biochemical remission following unilateral adrenalectomy in patients with PA.DESIGN AND PATIENTS: A retrospective study of patients with PA referred for AVS at Rigshospitalet from May 2011 to September 2020, who subsequently underwent adrenalectomy. Clinical remission was defined according to the PA surgical outcome criteria, whereas complete biochemical remission was defined as normalization of hypokalaemia without potassium substitution.RESULTS: Eighty-four patients were available for analysis of primary outcome. Among patients with CLS, 28/58 (48.3%) obtained complete clinical remission after surgery compared with 10/26 (38.5%) without CLS (p = .40). Complete biochemical remission was obtained in 55/58 (94.8%) of patients with CLS compared with 25/28 (89.3%) without CLS (p = .44). Female gender and lower number of antihypertensives at baseline were associated with higher odds for complete clinical remission, whereas none of the investigated variables were associated with biochemical remission.CONCLUSION: CLS was not significantly associated with complete clinical or biochemical remission in this cohort. Our results confirmed that female gender and lower number of antihypertensives were predictors of clinical remission.

KW - Adrenal Glands

KW - Adrenalectomy/methods

KW - Aldosterone

KW - Antihypertensive Agents

KW - Female

KW - Humans

KW - Hyperaldosteronism/drug therapy

KW - Prognosis

KW - Retrospective Studies

UR - http://www.scopus.com/inward/record.url?scp=85124602357&partnerID=8YFLogxK

U2 - 10.1111/cen.14678

DO - 10.1111/cen.14678

M3 - Journal article

C2 - 35060161

VL - 96

SP - 793

EP - 802

JO - Clinical Endocrinology

JF - Clinical Endocrinology

SN - 0300-0664

IS - 6

ER -

ID: 78010743