Context: Surgery performed in primary hyperaldosteronism (PAH) can achieve biological healing in almost all cases, but blood pressure healing is only obtained in 20 to 55% of cases. The aim of our study is to identify the anthropometric, biological and pathological factors that would be statistically associated with blood pressure outcome in patients after unilateral adrenalectomy for primary aldosteronism between 1996 and 2016.
Method: This is a monocentric retrospective study performed in Lille University Hospital. Patients have benefited from a preoperative evaluation and at least from a one year postoperative evaluation. They were considered; 1) cured on the blood pressure level if systolic blood pressure (SBP) one year postoperatively was lower than 140 mmHG and if diastolic blood pressure (DBP) was lower than 90 mmHG and without treatment, 2) improved if there was a decrease of 20 mmHG of the consultation SBP and/or a decrease of 10 mmHG of the consultation DBP one year postoperatively with either the same treatment or with less treatment or if the blood pressure was the same with less treatment 3) not improved if systolic and diastolic consultation blood pressure at one year postoperatoire was stable or increased and the number of treatments unchanged or increased.
Results: Seventy-five patients were included with a sex ratio of 40 women for 35 men. The average age of 51 years (±10 years). 68 patients had Conns adenoma and 7 patients had unconventional pathology of Conns adenoma. In terms of blood pressure, 18 patients (24%) were cured, 47 patients (62.7%) were improved and 10 patients (13.3%) were not improved postoperatively. Patients are more likely to be cured if they are female (P=0.009), if they are young (P<0.005), if the body mass index is low (P=0.006), if the level of pulsed blood pressure is low (P=0.029), or if there is no renal failure (P=0.034).
Conclusion: Unilateral adrenalectomy for PAH can cure or improve hypertension in 86% of patients. Female sex, young age, low body mass index, low preoperative pulsed blood pressure level and absence of renal insufficiency are good prognostic factors concerning blood pressure outcome of patients undergoing surgery for primary aldosteronism.
18 - 21 May 2019
European Society of Endocrinology