Comparison between adrenalectomy and medical therapy in the management of primary aldosteronism
Introduction: Primary aldosteronism (PA) is a disorder of the adrenal gland causing an autonomous overproduction of mineralocorticoids, leading to arterial hypertension. Objective: To assess outcome between adrenalectomy and the use of mineralocorticoid receptor antagonist (MRA) in primary aldos...
| Main Authors: | , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Malaysian Endocrine and Metabolic Society
2014
|
| Subjects: | |
| Online Access: | http://irep.iium.edu.my/48173/ http://irep.iium.edu.my/48173/ http://irep.iium.edu.my/48173/6/PP-041.pdf |
| Summary: | Introduction: Primary aldosteronism (PA) is a disorder of the adrenal gland
causing an autonomous overproduction of mineralocorticoids, leading to
arterial hypertension.
Objective: To assess outcome between adrenalectomy and the use of
mineralocorticoid receptor antagonist (MRA) in primary aldosteronism.
Materials and Methods
Registry of all patients with treated PA referred to our center from 2001 till
2013 were reviewed. Demographics of the patients and outcome one year
after treatment were analysed.
Results: There were 12 female and 10 male patients. Mean age was 49.23
± 11.3. Median duration of hypertension prior to diagnosis of PA was 7.5
± 8.3 years. Median aldosterone renin ratio was 53.2 (aldosterone in ng/
dL, renin in ng/ml/h). 82% had fludrocortisone suppression as confirmatory
test. 45.5% underwent adrenalectomy, 36.4% received MRA, with mean
dose of 75mg/day. Mean potassium level pre-treatment was 2.75 ±
0.72mmol/L, with post level of 4.35 ± 0.43mmol/L. In the adrenalectomy
arm, there was significant improvement in SBP (p=0.001) and potassium
level (p<0.001) post treatment. In the MRA arm, there was significant
improvement in SBP (p=0.001), DBP (p=0.001) and potassium level
(p=0.002). Post adrenalectomy patients required less anti-hypertensive
treatment compared to patients who received MRA (p=0.039). There
was no significant difference in blood pressure improvement (p=0.43 for
SBP, p=0.13 for DBP) and potassium improvement (p=0.58) between two
modalities of treatment.
Conclusion: Both adrenalectomy and medical therapy resulted in
significant improvement in both blood pressure and potassium level. Due to
the small number of subjects, only reduction of anti-hypertensive treatment
heralds the superiority of surgery over medical treatment in this study. |
|---|