Endocrine Abstracts

JOINT2653

Introduction and objectives: Primary aldosteronism (PA) is a leading cause of hypertension, affecting up to 11.2% of new cases due to excessive aldosterone production. It typically results from bilateral adrenal hyperplasia or unilateral conditions like aldosterone-producing adenomas (APA). While laparoscopic adrenalectomy is a common treatment for unilateral cases, some patients remain hypertensive due to lingering hyperplasia in the other adrenal gland. Research suggests that staining adrenal tissue for enzymes such as CYP11B2, CYP11B1, and CYP17A1 can help identify aldosterone-producing cells and predict surgical outcomes, highlighting the need for improved diagnostic methods to enhance treatment success.

Methods: Patients undergoing adrenalectomy for PA at one center were identified over a 10-year period. Clinical parameters such as patient demographics, lab results, imaging features, adrenal vein sampling results, and clinical outcomes were recorded. Pathology specimens were stained with aldosterone synthase (CYP11B2). Patterns of histochemistry were then described.

Results: A cohort of 30 patients diagnosed with primary aldosteronism (PA) who underwent adrenalectomy over a span of 10 years was examined. Preoperative adrenal vein sampling was performed on 27 patients. On average, patients were taking 3.03 antihypertensive medications prior to surgery, which decreased to 0.92 medications per patient postoperatively. Hypokalemia was present in 23 patients before surgery, with none exhibiting it afterward. Surgical outcomes revealed that 21 patients were completely cured, 4 showed improvement, and 5 did not experience a cure. Immunostaining analysis was performed on 19 cases, revealing the following distribution of patterns: 12 (63.2%) showed consistent staining, 4 (21.0%) showed variable staining, 2 (10.5%) displayed aldosterone-producing micronodules (APM), and 1 (5.2%) had no staining. Preoperative imaging did not identify adenomas in either of the APM cases, in 2 out of 12 cases with consistent staining, or in 1 out of 4 cases with variable staining. The case with no staining revealed an adenoma on the ipsilateral side, as well as one on the contralateral side. No definitive link was observed between histochemical findings and cure rates.

Conclusion: This study highlights the effectiveness of adrenalectomy in treating primary aldosteronism (PA), with significant improvements in blood pressure, potassium levels, and reduced antihypertensive use. While immunostaining identified distinct histochemical patterns, no clear correlation with outcomes was found. Despite this, most patients experienced a cure or improvement, supporting adrenalectomy as a viable treatment. Further research is needed to refine diagnostics and identify factors influencing surgical success.