The prognosis of primary aldosteronism achieved incomplete surgical remission and changes in plasma aldosterone, plasma renin activity, and biochemical indicators.

Abstract

Background: Some primary aldosteronism (PA) patients with spontaneous hypokalemia achieved incomplete remission after surgical treatment. In this study, we aimed to construct a nomogram to predict surgical benefits for primary aldosteronism (PA) patients with typical symptoms, incorporating changes in plasma aldosterone, plasma renin activity (PRA), and aldosterone/renin ratio (ARR) to help clinicians assess prognosis and develop optimised treatment plans.

Methods: This retrospective cohort study enrolled 162 patients between January 2017 and January 2024. Baseline characteristics, clinical indicators, and biochemical results, including plasma aldosterone, PRA, ARR, and serum potassium, were compared among patients with different clinical and biochemical outcomes. A nomogram was developed and internally validated with risk factors selected from univariate and multivariate logistic regression analyses.

Results: Complete clinical and biochemical success was achieved in 69 (42.6%) and 129 (79.6%). Five risk factors were used to develop a nomogram. The area under the receiver operating characteristic curve (AUC) was 0.856 (0.788-0.924) in the training dataset and 0.726 (0.580-0.872) in the validation dataset. The calibration curve showed good agreement, and the decision curve analysis demonstrated the clinical utility of this model.

Conclusions: PA patients with older age, higher systolic blood pressure, lower plasma aldosterone, more than 5 years of hypertension, and an adrenal gland mass on the left side or both sides had more probability of achieving incomplete remission after the surgery.