A New Disease Severity Score for Measuring Treatment Response to Adrenalectomy in Patients With Primary Aldosteronism

IF 3.7 3区医学 Q2 ENDOCRINOLOGY & METABOLISM

Endocrine Practice Pub Date : 2024-11-01 DOI:10.1016/j.eprac.2024.09.001

Ege Akgun MD , Edip Memisoglu MD , Arturan Ibrahimli MD , Gizem Isiktas MD , Ram K. Gurajala MD , Erick Remer MD , Dingfeng Li MD , Pratibha Rao MD , Ricardo Correa Marquez MD , Eren Berber MD, MBA

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Abstract

Objective

Cure after adrenalectomy for primary aldosteronism has been reported in only 15% to 40% of patients, with no disease severity score available to measure response objectively. Furthermore, the criteria used to define cure are outdated. This study aims to determine the rate of cure based on the current definition of normal blood pressure and develop a disease severity score to measure clinical improvement after adrenalectomy for primary aldosteronism.

Methods

This was a retrospective single-center study that included patients who underwent adrenalectomy for primary aldosteronism between 2000 and 2023. Blood pressure, a defined daily dose of antihypertensives, and potassium supplementation were incorporated into a new Primary Aldosteronism Disease Severity Score (PADSS), which was calculated with preoperative and 6-month postoperative parameters.

Results

The study included 201 patients. Adrenalectomy was guided by adrenal venous sampling in 86.1% of patients. The cure rate per the new definition of normal blood pressure was 7.5% (n = 15). The median PADSS was 16.3 (13.6-19.9) preoperatively and decreased to 10 (4.5-13.3) postoperatively. An improvement of the PADSS was observed in 90% (n = 180) of patients at 6 months of adrenalectomy. The median rate of improvement in PADSS was 33.3% (13.8% to 56.6%).

Conclusions

Although complete cure rates are low after adrenalectomy in primary aldosteronism, especially based on the new definition of normal blood pressure, a clinical improvement is seen in the vast majority of patients postoperatively. The newly introduced PADSS can be used to assess the clinical benefit achieved with adrenalectomy.

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衡量原发性醛固酮增多症患者对肾上腺切除术治疗反应的新疾病严重程度评分。

目的据报道，原发性醛固酮增多症肾上腺切除术后仅有 15%-40% 的患者治愈，而且没有疾病严重程度评分来客观衡量患者的反应。此外，用于定义治愈的标准已经过时。本研究旨在根据目前正常血压的定义确定治愈率，并制定疾病严重程度评分，以衡量原发性醛固酮增多症肾上腺切除术后的临床改善情况。方法这是一项回顾性单中心研究，纳入了 2000 年至 2023 年间因原发性醛固酮增多症接受肾上腺切除术的患者。血压、规定的每日降压药剂量和钾补充被纳入新的原发性醛固酮增多症疾病严重程度评分（PADSS），该评分根据术前和术后 6 个月的参数计算得出。86.1%的患者在肾上腺静脉取样的指导下进行了肾上腺切除术。根据正常血压的新定义，治愈率为 7.5%（n=15）。术前的 PADSS 中位数为 16.3 [13.6-19.9]，术后降至 10 [4.5-13.3]。肾上腺切除术后六个月，90% 的患者（约 180 人）的 PADSS 均有所改善。结论虽然原发性醛固酮增多症肾上腺切除术后的完全治愈率较低，尤其是根据正常血压的新定义，但绝大多数患者术后的临床症状都有所改善。新引入的原发性醛固酮增多症疾病严重程度评分（PADSS）可用于评估肾上腺切除术的临床疗效。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Endocrine Practice ENDOCRINOLOGY & METABOLISM-

CiteScore

7.60

自引率

2.40%

发文量

546

审稿时长

41 days

期刊介绍： Endocrine Practice (ISSN: 1530-891X), a peer-reviewed journal published twelve times a year, is the official journal of the American Association of Clinical Endocrinologists (AACE). The primary mission of Endocrine Practice is to enhance the health care of patients with endocrine diseases through continuing education of practicing endocrinologists.