Appropriate timing for a biochemical evaluation after adrenalectomy for unilateral aldosterone-producing adenoma.
adrenalectomy
endocrine
follow-up
primary aldosteronism
Journal
Clinical endocrinology
ISSN: 1365-2265
Titre abrégé: Clin Endocrinol (Oxf)
Pays: England
ID NLM: 0346653
Informations de publication
Date de publication:
06 2020
06 2020
Historique:
received:
27
12
2019
revised:
01
02
2020
accepted:
04
02
2020
pubmed:
19
2
2020
medline:
19
8
2021
entrez:
19
2
2020
Statut:
ppublish
Résumé
The oversecretion of plasma aldosterone by unilateral aldosterone-producing adenoma (APA) can be cured by adrenalectomy. However, the time needed for the endocrine environment to normalize remains unclear. To clarify adequate timing for a biochemical evaluation in unilateral APA patients after adrenalectomy. A total of 166 unilateral APA patients were retrospectively reviewed. We evaluated the plasma aldosterone concentration (PAC) (pg/mL), active renin concentration (ARC) (pg/mL), aldosterone-renin ratio (ARR; PAC/ARC), serum potassium concentration and estimated glomerular filtration rate (eGFR) at 1, 3 and 6 postoperation months (POM). PAC was significantly lower at 1POM than at presurgery (presurgery; 407.2, 1 POM; 90.0 pg/mL, P < .001). ARC did not increase from baseline at 1POM, but significantly increased at 3POM (presurgery; 4.43, 1POM; 4.87, 3POM; 11.3 pg/mL, P < .001). ARR significantly decreased at 1POM (presurgery; 146.9, 1 POM; 26.3, P < .001) although ARC did not increase at 1POM. Among the 34 patients who had hypokalaemia presurgery, it was resolved in 28 (82%) at 1POM and in all (100%) at 3POM. The biochemical outcomes at 1POM were 131 (79%) complete, 20 (12%) partial and 15 (9%) absent successes, while at 3POM, 147 (89%) were complete, 9 (5%) partial and 10 (6%) absent. Twenty-three (14%) patients were reclassified into different biochemical outcomes between 1 and 3POM, whereas only 5 (3%) changed between 3 and 6POM. The appropriate timing for a biochemical evaluation of unilateral APA patients treated with laparoscopic adrenalectomy appears to be 3 months or more after surgery.
Substances chimiques
Aldosterone
4964P6T9RB
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
503-508Informations de copyright
© 2020 John Wiley & Sons Ltd.
Références
Funder JW, Carey RM, Mantero F, et al. The management of primary aldosteronism: case detection, diagnosis, and treatment: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2016;101(5):1889-1916.
Milliez P, Girerd X, Plouin PF, Blacher J, Safar ME, Mourad JJ. Evidence for an increased rate of cardiovascular events in patients with primary aldosteronism. J Am Coll Cardiol. 2005;45(8):1243-1248.
Rossi GP, Bernini G, Caliumi C, et al. A prospective study of the prevalence of primary aldosteronism in 1,125 hypertensive patients. J Am Coll Cardiol. 2006;48(11):2293-2300.
Monticone S, Burrello J, Tizzani D, et al. Prevalence and clinical manifestations of primary aldosteronism encountered in primary care practice. J Am Coll Cardiol. 2017;69(14):1811-1820.
Lumachi F, Ermani M, Basso SM, Armanini D, Iacobone M, Favia G. Long-term results of adrenalectomy in patients with aldosterone-producing adenomas: multivariate analysis of factors affecting unresolved hypertension and review of the literature. Am Surg. 2005;71(10):864-869.
Williams TA, Lenders JWM, Mulatero P, et al. Outcomes after adrenalectomy for unilateral primary aldosteronism: an international consensus on outcome measures and analysis of remission rates in an international cohort. Lancet Diabetes Endocrinol. 2017;5(9):689-699.
Nishikawa T, Omura M, Satoh F, et al. Guidelines for the diagnosis and treatment of primary aldosteronism-the Japan Endocrine Society 2009. Endocr J. 2011;58(9):711-721.
Matsuo S, Imai E, Horio M, et al. Revised equations for estimated GFR from serum creatinine in Japan. Am J Kidney Dis. 2009;53(6):982-992.
Starker LF, Christakis I, Julien JS, et al. Considering postoperative functional hypoaldosteronism after unilateral adrenalectomy. Am Surg. 2017;83(6):598-604.
Burrello J, Burrello A, Stowasser M, et al. The primary aldosteronism surgical outcome score for the prediction of clinical outcomes after adrenalectomy for unilateral primary aldosteronism. Ann Surg 2019. https://doi.org/10.1097/SLA.0000000000003200. [Epub ahead of print].
Swearingen AJ, Kahramangil B, Monteiro R, et al. Analysis of postoperative biochemical values and clinical outcomes after adrenalectomy for primary aldosteronism. Surgery. 2018;163(4):807-810.
Byrd JB, Turcu AF, Auchus RJ. Primary aldosteronism. Circulation. 2018;138(8):823-835.
Damkjaer M, Isaksson GL, Stubbe J, Jensen BL, Assersen K, Bie P. Renal renin secretion as regulator of body fluid homeostasis. Pflugers Archiv. 2013;465(1):153-165.
Kim IY, Park IS, Kim MJ, et al. Change in kidney function after unilateral adrenalectomy in patients with primary aldosteronism: identification of risk factors for decreased kidney function. Int Urol Nephrol. 2018;50(10):1887-1895.
Hundemer GL, Curhan GC, Yozamp N, Wang M, Vaidya A. Renal outcomes in medically and surgically treated primary aldosteronism. Hypertension. 2018;72(3):658-666.
Stowasser M, Gordon RD. Primary aldosteronism: changing definitions and new concepts of physiology and pathophysiology both inside and outside the kidney. Physiol Rev. 2016;96(4):1327-1384.
Young JrWF. Minireview: primary aldosteronism-changing concepts in diagnosis and treatment. Endocrinology. 2003;144(6):2208-2213.