Primary aldosteronism (PA) has a prevalence of 515% in the general population with hypertension and patients with PA display an increased frequency of target organ damage and cardiovascular damage than patients with hypertension with matched cardiovascular risk profiles. The unilateral and bilateral forms of PA are treated differently usually surgically (unilateral PA) or by antagonism of the receptor for aldosterone (bilateral PA). Medically-treated patients with PA have an increased risk of cardiovascular events which is likely related to insufficient mineralocorticoid receptor blockade. Surgically treated patients with unilateral PA can be potentially cured but a wide between-centre variability has been demonstrated. An expert-based consensus established standard criteria to assess clinical and biochemical outcomes after unilateral adrenalectomy (the Primary Aldosteronism Surgical Outcome [PASO] consensus). Application of these criteria to an international cohort demonstrated that less than half of patients are clinically cured (37%, range 1762) and showed that younger and female individuals are more likely to achieve clinical remission. The identification of baseline factors associated with post-surgical outcomes were used to develop an online score employing 6 presurgical variables for the prediction of clinical remission versus patients with likely persistant hypertension after surgery (the PASO predictor). Analysis of adrenal specimens from patients with PA showed that adrenals from patients with persistent aldosteronism after surgery more frequently display signs of hyperplasia and no obvious aldosterone-producing adenoma than those from patients surgically cured of aldosteronism. These approaches are relevant to the clinical setting for the differentiation of patients who are likely to be clinically and biochemically cured after surgery from those who will need continuous surveillance after surgery due to persistent hypertension and primary aldosteronism.
18 - 21 May 2019
European Society of Endocrinology