Introduction: Unilateral forms or primary aldosteronism (PA) can be treated by adrenalectomy of by mineralocorticoid receptor antagonists, whereas bilateral forms are always treated by mineralocorticoid receptor antagonists. Most studies find similar results for the control of blood pressure and kalemia, but also to reverse organ damages, however recent studies are discordant and show a benefit of adrenalectomy regarding cardiovascular events and blood pressure (BP). Regarding these discrepancies, we wanted to evaluate the outcomes of PA treatments in clinical practice.
Methods: 148 patients diagnosed for PA in our center with the realization of an adrenal venous sampling between January 2009 and December 2012 and evaluated after five years were included. Patients with no active follow-up in our center were contacted for a medical consultation or a telephonic standardized interview.
Results: Surgical and medical treatments provided similarly BP (OR=0,308 [0,2771,335]) and kalemia control, for 70% of followed patients. Hypokalemia was persistent in 15.9% of patients in the medically treated group versus none among the patients who underwent surgery. We observed 7% of cardiovascular events without differences according to the treatment (P=0.246). Renal function was slightly better after surgery. Surgical treatment allowed 39% of cure rate and a significant decrease of the daily defined dose (DDD) of 2.5.
Conclusion: 80 months after the diagnosis, medical and surgical treatment of PA are similar for the control of blood pressure. No difference in the occurrence of cardiovascular events appears according to the treatment. The benefice of surgery is especially represented by the reduction of antihypertensive drugs, the cure of hypokalemia and the cure rate of 39%.
18 - 21 May 2019
European Society of Endocrinology