Surgery based on computed tomography images might be feasible for primary aldosteronism patients with visible unilateral adenoma
Abstract Primary aldosteronism (PA) with unilateral adrenal disease can be cured or improved by adrenalectomy. Adrenal venous sampling (AVS) is recommended to identify patients for surgical management. However, surgeries based on computed tomography (CT) images are only advocated for PA patients age...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2023-11-01
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| Series: | The Journal of Clinical Hypertension |
| Subjects: | |
| Online Access: | https://doi.org/10.1111/jch.14725 |
| _version_ | 1797633638473400320 |
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| author | Chen Fang Jun Dai Juping Zhao Xin Huang Wei He Jianzhong Xu Fukang Sun |
| author_facet | Chen Fang Jun Dai Juping Zhao Xin Huang Wei He Jianzhong Xu Fukang Sun |
| author_sort | Chen Fang |
| collection | DOAJ |
| description | Abstract Primary aldosteronism (PA) with unilateral adrenal disease can be cured or improved by adrenalectomy. Adrenal venous sampling (AVS) is recommended to identify patients for surgical management. However, surgeries based on computed tomography (CT) images are only advocated for PA patients aged <35 with visible unilateral adenoma. Herein, we aimed to compare CT‐based and AVS‐based surgery outcomes for PA patients with visible unilateral adenomas for different age groups. A total of 178 PA patients who underwent unilateral adrenalectomy between June 2018 and January 2021 were included in the study based on CT (n = 54) or AVS (n = 124). Demographics, diagnostics, and follow‐up data were retrospectively collected. Clinical and biochemical outcomes were analyzed according to Primary Aldosteronism Surgical Outcome (PASO) criteria at 1‐year follow‐up. Our results showed that complete clinical success (46.3% vs. 47.6%, p = 0.875) and complete biochemical success (88.8% vs. 91.9%, p = 0.515) were similar between the two groups. Age stratification revealed that patients >55 years old were likely to have worse biochemical outcomes; however, these were still not significantly different (21.4% vs. 8.6%, p = 0.220). Of the 114 AVS‐based patients who achieved complete biochemical success, 37 (32.4%) with bilateral normal or bilateral abnormal CT images changed treatment options according to AVS results, 1 (0.9%) avoided adrenalectomy on the wrong side. Our results indicated that surgery based on CT images might be feasible for highly selected PA patients with visible unilateral adenomas and less limited by age, while for those with normal adrenal or bilateral adrenal lesions, treatment strategy must be decided by AVS. |
| first_indexed | 2024-03-11T11:56:42Z |
| format | Article |
| id | doaj.art-5576380a78404cf68a9ddda18478fbdc |
| institution | Directory Open Access Journal |
| issn | 1524-6175 1751-7176 |
| language | English |
| last_indexed | 2024-03-11T11:56:42Z |
| publishDate | 2023-11-01 |
| publisher | Wiley |
| record_format | Article |
| series | The Journal of Clinical Hypertension |
| spelling | doaj.art-5576380a78404cf68a9ddda18478fbdc2023-11-08T12:16:50ZengWileyThe Journal of Clinical Hypertension1524-61751751-71762023-11-0125111001100810.1111/jch.14725Surgery based on computed tomography images might be feasible for primary aldosteronism patients with visible unilateral adenomaChen Fang0Jun Dai1Juping Zhao2Xin Huang3Wei He4Jianzhong Xu5Fukang Sun6Department of Urology Ruijin Hospital Shanghai Jiao Tong University School of Medicine Shanghai ChinaDepartment of Urology Ruijin Hospital Shanghai Jiao Tong University School of Medicine Shanghai ChinaDepartment of Urology Ruijin Hospital Shanghai Jiao Tong University School of Medicine Shanghai ChinaDepartment of Urology Ruijin Hospital Shanghai Jiao Tong University School of Medicine Shanghai ChinaDepartment of Urology Ruijin Hospital Shanghai Jiao Tong University School of Medicine Shanghai ChinaDepartment of Hypertension Ruijin Hospital Shanghai Jiao Tong University School of Medicine Shanghai ChinaDepartment of Urology Ruijin Hospital Shanghai Jiao Tong University School of Medicine Shanghai ChinaAbstract Primary aldosteronism (PA) with unilateral adrenal disease can be cured or improved by adrenalectomy. Adrenal venous sampling (AVS) is recommended to identify patients for surgical management. However, surgeries based on computed tomography (CT) images are only advocated for PA patients aged <35 with visible unilateral adenoma. Herein, we aimed to compare CT‐based and AVS‐based surgery outcomes for PA patients with visible unilateral adenomas for different age groups. A total of 178 PA patients who underwent unilateral adrenalectomy between June 2018 and January 2021 were included in the study based on CT (n = 54) or AVS (n = 124). Demographics, diagnostics, and follow‐up data were retrospectively collected. Clinical and biochemical outcomes were analyzed according to Primary Aldosteronism Surgical Outcome (PASO) criteria at 1‐year follow‐up. Our results showed that complete clinical success (46.3% vs. 47.6%, p = 0.875) and complete biochemical success (88.8% vs. 91.9%, p = 0.515) were similar between the two groups. Age stratification revealed that patients >55 years old were likely to have worse biochemical outcomes; however, these were still not significantly different (21.4% vs. 8.6%, p = 0.220). Of the 114 AVS‐based patients who achieved complete biochemical success, 37 (32.4%) with bilateral normal or bilateral abnormal CT images changed treatment options according to AVS results, 1 (0.9%) avoided adrenalectomy on the wrong side. Our results indicated that surgery based on CT images might be feasible for highly selected PA patients with visible unilateral adenomas and less limited by age, while for those with normal adrenal or bilateral adrenal lesions, treatment strategy must be decided by AVS.https://doi.org/10.1111/jch.14725adrenal vein samplingadrenalectomycomputed tomographyhyperaldosteronismsurgical outcomes |
| spellingShingle | Chen Fang Jun Dai Juping Zhao Xin Huang Wei He Jianzhong Xu Fukang Sun Surgery based on computed tomography images might be feasible for primary aldosteronism patients with visible unilateral adenoma The Journal of Clinical Hypertension adrenal vein sampling adrenalectomy computed tomography hyperaldosteronism surgical outcomes |
| title | Surgery based on computed tomography images might be feasible for primary aldosteronism patients with visible unilateral adenoma |
| title_full | Surgery based on computed tomography images might be feasible for primary aldosteronism patients with visible unilateral adenoma |
| title_fullStr | Surgery based on computed tomography images might be feasible for primary aldosteronism patients with visible unilateral adenoma |
| title_full_unstemmed | Surgery based on computed tomography images might be feasible for primary aldosteronism patients with visible unilateral adenoma |
| title_short | Surgery based on computed tomography images might be feasible for primary aldosteronism patients with visible unilateral adenoma |
| title_sort | surgery based on computed tomography images might be feasible for primary aldosteronism patients with visible unilateral adenoma |
| topic | adrenal vein sampling adrenalectomy computed tomography hyperaldosteronism surgical outcomes |
| url | https://doi.org/10.1111/jch.14725 |
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