Primary Aldosteronism: Does Underlying Pathology Impact Clinical Presentation and Outcomes Following Unilateral Adrenalectomy?

Omair A. Shariq, Kabir Mehta, Geoffrey B. Thompson, Melanie L. Lyden, David R. Farley, Irina Bancos, Benzon M. Dy, William Francis Young, Travis J. McKenzie

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Introduction: Patients undergoing unilateral adrenalectomy for primary aldosteronism (PA) may have a solitary adenoma, unilateral hyperplasia, or multiple adenomas on final pathology. This study investigated whether the underlying pathological diagnosis was associated with differences in clinical presentation and postoperative outcomes. Methods: A retrospective cohort study of patients undergoing unilateral adrenalectomy for PA from 2004 to 2015 at our institution was performed. Baseline clinical and laboratory parameters, as well as postoperative biochemical and hypertension cure rates, were compared across the three aforementioned pathological groups. Results: Of 206 patients who met criteria for inclusion, 152 (73.8%) had a single adenoma, 33 (16%) had unilateral hyperplasia, and 21 (10.2%) had multiple unilateral adenomas. Patients with unilateral hyperplasia were more likely to be male (81.2% vs 57.9%, P =.03), undergo left-sided adrenalectomy (78.8% vs 47.4%, P <.01), and had a lower median adrenal venous sampling lateralization index (9.8 vs 19.8, P =.04) compared to those with solitary, but not multiple unilateral adenomas. No differences were seen in age, duration of hypertension, preoperative plasma aldosterone levels, plasma renin activities, 24-h urinary aldosterone excretion, serum potassium concentrations, and the number of preoperative antihypertensive medications across all three pathological groups. All patients achieved biochemical cure following adrenalectomy, and no significant differences in the rates of hypertension cure or improvement were observed in comparisons across pathological subtype. Conclusions: Clinical presentation and postoperative outcomes are similar regardless of underlying pathology in patients with PA. Because one in four patients may harbor unilateral hyperplasia or multiple adenomas, total unilateral adrenalectomy should be performed as the operation of choice over adrenal-sparing approaches.

Original languageEnglish (US)
JournalWorld Journal of Surgery
DOIs
StatePublished - Jan 1 2019

Fingerprint

Hyperaldosteronism
Clinical Pathology
Adrenalectomy
Adenoma
Hyperplasia
Hypertension
Aldosterone
Pathology
Renin
Antihypertensive Agents
Potassium
Cohort Studies
Retrospective Studies
Serum

ASJC Scopus subject areas

  • Surgery

Cite this

Primary Aldosteronism : Does Underlying Pathology Impact Clinical Presentation and Outcomes Following Unilateral Adrenalectomy? / Shariq, Omair A.; Mehta, Kabir; Thompson, Geoffrey B.; Lyden, Melanie L.; Farley, David R.; Bancos, Irina; Dy, Benzon M.; Young, William Francis; McKenzie, Travis J.

In: World Journal of Surgery, 01.01.2019.

Research output: Contribution to journalArticle

Shariq, Omair A. ; Mehta, Kabir ; Thompson, Geoffrey B. ; Lyden, Melanie L. ; Farley, David R. ; Bancos, Irina ; Dy, Benzon M. ; Young, William Francis ; McKenzie, Travis J. / Primary Aldosteronism : Does Underlying Pathology Impact Clinical Presentation and Outcomes Following Unilateral Adrenalectomy?. In: World Journal of Surgery. 2019.
@article{937725aa23774334b1745467fde5e113,
title = "Primary Aldosteronism: Does Underlying Pathology Impact Clinical Presentation and Outcomes Following Unilateral Adrenalectomy?",
abstract = "Introduction: Patients undergoing unilateral adrenalectomy for primary aldosteronism (PA) may have a solitary adenoma, unilateral hyperplasia, or multiple adenomas on final pathology. This study investigated whether the underlying pathological diagnosis was associated with differences in clinical presentation and postoperative outcomes. Methods: A retrospective cohort study of patients undergoing unilateral adrenalectomy for PA from 2004 to 2015 at our institution was performed. Baseline clinical and laboratory parameters, as well as postoperative biochemical and hypertension cure rates, were compared across the three aforementioned pathological groups. Results: Of 206 patients who met criteria for inclusion, 152 (73.8{\%}) had a single adenoma, 33 (16{\%}) had unilateral hyperplasia, and 21 (10.2{\%}) had multiple unilateral adenomas. Patients with unilateral hyperplasia were more likely to be male (81.2{\%} vs 57.9{\%}, P =.03), undergo left-sided adrenalectomy (78.8{\%} vs 47.4{\%}, P <.01), and had a lower median adrenal venous sampling lateralization index (9.8 vs 19.8, P =.04) compared to those with solitary, but not multiple unilateral adenomas. No differences were seen in age, duration of hypertension, preoperative plasma aldosterone levels, plasma renin activities, 24-h urinary aldosterone excretion, serum potassium concentrations, and the number of preoperative antihypertensive medications across all three pathological groups. All patients achieved biochemical cure following adrenalectomy, and no significant differences in the rates of hypertension cure or improvement were observed in comparisons across pathological subtype. Conclusions: Clinical presentation and postoperative outcomes are similar regardless of underlying pathology in patients with PA. Because one in four patients may harbor unilateral hyperplasia or multiple adenomas, total unilateral adrenalectomy should be performed as the operation of choice over adrenal-sparing approaches.",
author = "Shariq, {Omair A.} and Kabir Mehta and Thompson, {Geoffrey B.} and Lyden, {Melanie L.} and Farley, {David R.} and Irina Bancos and Dy, {Benzon M.} and Young, {William Francis} and McKenzie, {Travis J.}",
year = "2019",
month = "1",
day = "1",
doi = "10.1007/s00268-019-05059-y",
language = "English (US)",
journal = "Presentations from the 9th Annual Electric Utilities Environmental Conference",
issn = "0364-2313",
publisher = "Springer New York",

}

TY - JOUR

T1 - Primary Aldosteronism

T2 - Does Underlying Pathology Impact Clinical Presentation and Outcomes Following Unilateral Adrenalectomy?

AU - Shariq, Omair A.

AU - Mehta, Kabir

AU - Thompson, Geoffrey B.

AU - Lyden, Melanie L.

AU - Farley, David R.

AU - Bancos, Irina

AU - Dy, Benzon M.

AU - Young, William Francis

AU - McKenzie, Travis J.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Introduction: Patients undergoing unilateral adrenalectomy for primary aldosteronism (PA) may have a solitary adenoma, unilateral hyperplasia, or multiple adenomas on final pathology. This study investigated whether the underlying pathological diagnosis was associated with differences in clinical presentation and postoperative outcomes. Methods: A retrospective cohort study of patients undergoing unilateral adrenalectomy for PA from 2004 to 2015 at our institution was performed. Baseline clinical and laboratory parameters, as well as postoperative biochemical and hypertension cure rates, were compared across the three aforementioned pathological groups. Results: Of 206 patients who met criteria for inclusion, 152 (73.8%) had a single adenoma, 33 (16%) had unilateral hyperplasia, and 21 (10.2%) had multiple unilateral adenomas. Patients with unilateral hyperplasia were more likely to be male (81.2% vs 57.9%, P =.03), undergo left-sided adrenalectomy (78.8% vs 47.4%, P <.01), and had a lower median adrenal venous sampling lateralization index (9.8 vs 19.8, P =.04) compared to those with solitary, but not multiple unilateral adenomas. No differences were seen in age, duration of hypertension, preoperative plasma aldosterone levels, plasma renin activities, 24-h urinary aldosterone excretion, serum potassium concentrations, and the number of preoperative antihypertensive medications across all three pathological groups. All patients achieved biochemical cure following adrenalectomy, and no significant differences in the rates of hypertension cure or improvement were observed in comparisons across pathological subtype. Conclusions: Clinical presentation and postoperative outcomes are similar regardless of underlying pathology in patients with PA. Because one in four patients may harbor unilateral hyperplasia or multiple adenomas, total unilateral adrenalectomy should be performed as the operation of choice over adrenal-sparing approaches.

AB - Introduction: Patients undergoing unilateral adrenalectomy for primary aldosteronism (PA) may have a solitary adenoma, unilateral hyperplasia, or multiple adenomas on final pathology. This study investigated whether the underlying pathological diagnosis was associated with differences in clinical presentation and postoperative outcomes. Methods: A retrospective cohort study of patients undergoing unilateral adrenalectomy for PA from 2004 to 2015 at our institution was performed. Baseline clinical and laboratory parameters, as well as postoperative biochemical and hypertension cure rates, were compared across the three aforementioned pathological groups. Results: Of 206 patients who met criteria for inclusion, 152 (73.8%) had a single adenoma, 33 (16%) had unilateral hyperplasia, and 21 (10.2%) had multiple unilateral adenomas. Patients with unilateral hyperplasia were more likely to be male (81.2% vs 57.9%, P =.03), undergo left-sided adrenalectomy (78.8% vs 47.4%, P <.01), and had a lower median adrenal venous sampling lateralization index (9.8 vs 19.8, P =.04) compared to those with solitary, but not multiple unilateral adenomas. No differences were seen in age, duration of hypertension, preoperative plasma aldosterone levels, plasma renin activities, 24-h urinary aldosterone excretion, serum potassium concentrations, and the number of preoperative antihypertensive medications across all three pathological groups. All patients achieved biochemical cure following adrenalectomy, and no significant differences in the rates of hypertension cure or improvement were observed in comparisons across pathological subtype. Conclusions: Clinical presentation and postoperative outcomes are similar regardless of underlying pathology in patients with PA. Because one in four patients may harbor unilateral hyperplasia or multiple adenomas, total unilateral adrenalectomy should be performed as the operation of choice over adrenal-sparing approaches.

UR - http://www.scopus.com/inward/record.url?scp=85067679246&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85067679246&partnerID=8YFLogxK

U2 - 10.1007/s00268-019-05059-y

DO - 10.1007/s00268-019-05059-y

M3 - Article

C2 - 31214831

AN - SCOPUS:85067679246

JO - Presentations from the 9th Annual Electric Utilities Environmental Conference

JF - Presentations from the 9th Annual Electric Utilities Environmental Conference

SN - 0364-2313

ER -