Comparative Outcomes of Adrenalectomy, Mineralocorticoid Receptor Antagonist, and Percutaneous Adrenal Ablation for Primary Aldosteronism: A Systematic Review and Network Meta-Analysis.

Background: Percutaneous adrenal ablation (PAA) is an effective and safe therapy for treating patients with primary aldosteronism (PA). However, its effectiveness in comparison to that of adrenalectomy (ADX) and mineralocorticoid receptor antagonists (MRAs) remains unclear.

Methods: Databases were searched including PubMed, Embase, and The Cochrane Library. Studies included patients with PA who received two of three different treatments (ADX, MRAs, or PAA) and reported our interested outcomes, including blood pressure, serum potassium, and the aldosterone-to-renin ratio (ARR).

Results: In a total of 10,681 patients from 47 studies were identified. Both ADX and PAA showed superior clinical success (systolic blood pressure (BP): ADX: -4.69 (-6.4, -2.95), PAA: -3.96 (-9.05, 0.99); diastolic BP: ADX: -3.14 (-4.55, -1.85), PAA: -2.99 (-6.96, 0.98)) compared with MRAs. According to the Bayesian ranking curves (surface under the cumulative ranking values), ADX ranked first for all outcomes of interest (systolic BP: 81.02%, diastolic BP: 76.95%, serum potassium: 96.55%, and ARR: 88.03%), while PAA ranked second for all outcomes (systolic BP: 65.94%, diastolic BP: 69.66%, serum potassium: 50%, and ARR: 45.14%).

Conclusions: The findings of this network meta-analysis suggest that PAA could be an alternative treatment for patients with PA who are unable to opt for surgery or MRA therapy, and its clinical and biochemical success falls between those of ADX and MRAs.