Proportion of Patients With Hypertension Resolution Following Adrenalectomy for Primary Aldosteronism: A Systematic Review and Meta-Analysis

Overview

Journal J Clin Hypertens (Greenwich)

Specialty Cardiology & Vascular Diseases

Date 2016 Oct 21

PMID 27759187

Citations 14

Authors

Jamie L Benham

Maysoon Eldoma

Bushra Khokhar

Derek J Roberts

Doreen M Rabi

Gregory A Kline

Affiliations

Soon will be listed here.

Abstract

Unilateral primary aldosteronism (PA) is often treated with adrenalectomy, but hypertension resolution rates are variable. A valid estimate of the postoperative normotension rate is necessary to inform the utility of PA testing and treatment. The authors searched MEDLINE In-Process & Other Non-Indexed Citations, Embase, and Cochrane Central Register of Controlled Trials. Prospective adult cohort studies with surgically treated PA that reported resolution of hypertension without the aid of medications were included. Among 2620 abstracts identified by the search, 25 studies in the systematic review with data on 1685 patients were investigated. The pooled proportion of normotension following adrenalectomy was 52% (95% confidence interval, 0.44-0.60). Meta-regression demonstrated a significant negative association between length of follow-up and proportion of normotension, with normotension dropping by 6.7% per year of follow-up (coefficient -0.006; 95% confidence interval, -0.01 to 0.002). Overall, approximately half of the patients experienced hypertension resolution, although this outcome may not be durable in all patients.

Citing Articles

Discordance between adrenal vein sampling and imaging: the role of unilateral cortisol excess.

Grundy M, Leung A, Hyrcza M, Pasieka J, Chan D, Przybojewski S Eur J Endocrinol. 2025; 192(3):191-201.

PMID: 39960854 PMC: 11894521. DOI: 10.1093/ejendo/lvaf019.

Diagnosis and management of adrenal incidentaloma: use of clinical judgment and evidence in dialog with the patient.

Yoshida Y, Horiuchi K, Otsuki M, Okamoto T Surg Today. 2023; 54(12):1417-1427.

PMID: 38091063 PMC: 11582175. DOI: 10.1007/s00595-023-02781-y.

Diagnosis and management of primary hyperaldosteronism in patients with hypertension: a practical approach endorsed by the British and Irish Hypertension Society.

Faconti L, Kulkarni S, Delles C, Kapil V, Lewis P, Glover M J Hum Hypertens. 2023; 38(1):8-18.

PMID: 37964158 PMC: 10803267. DOI: 10.1038/s41371-023-00875-1.

Predictors of successful outcome after adrenalectomy for unilateral primary aldosteronism.

Saadi A, Bedoui M, Zaghbib S, Boussaffa H, Mokaddem S, Ben Nacef I Front Endocrinol (Lausanne). 2023; 14:1205988.

PMID: 37635962 PMC: 10454906. DOI: 10.3389/fendo.2023.1205988.

Clinical cure vs a novel trifecta system for evaluating long-term outcomes of minimally-invasive partial or total adrenalectomy for unilateral primary aldosteronism: results of a multicentric series.

Anceschi U, Tufano A, Flammia R, Mormando M, Fiori C, Zappala O Cent European J Urol. 2023; 75(4):345-351.

PMID: 36794029 PMC: 9903164. DOI: 10.5173/ceju.2022.147.

References

Benham J, Eldoma M, Khokhar B, Roberts D, Rabi D, Kline G . Proportion of Patients With Hypertension Resolution Following Adrenalectomy for Primary Aldosteronism: A Systematic Review and Meta-Analysis. J Clin Hypertens (Greenwich). 2016; 18(12):1205-1212. PMC: 8031514. DOI: 10.1111/jch.12916. View

Rossi G, Sechi L, Giacchetti G, Ronconi V, Strazzullo P, Funder J . Primary aldosteronism: cardiovascular, renal and metabolic implications. Trends Endocrinol Metab. 2008; 19(3):88-90. DOI: 10.1016/j.tem.2008.01.006. View

Potthoff S, Beuschlein F, Vonend O . [Primay hyperaldosteronism--diagnostic and treatment]. Dtsch Med Wochenschr. 2012; 137(48):2480-4. DOI: 10.1055/s-0032-1327318. View

Volpe C, Hamberger B, Hoog A, Mukai K, Calissendorff J, Wahrenberg H . Primary aldosteronism: functional histopathology and long-term follow-up after unilateral adrenalectomy. Clin Endocrinol (Oxf). 2014; 82(5):639-47. DOI: 10.1111/cen.12645. View

Worth P, Kunio N, Siegfried I, Sheppard B, Gilbert E . Characteristics predicting clinical improvement and cure following laparoscopic adrenalectomy for primary aldosteronism in a large cohort. Am J Surg. 2015; 210(4):702-9. DOI: 10.1016/j.amjsurg.2015.05.033. View

Omura M, Saito J, Yamaguchi K, Kakuta Y, Nishikawa T . Prospective study on the prevalence of secondary hypertension among hypertensive patients visiting a general outpatient clinic in Japan. Hypertens Res. 2004; 27(3):193-202. DOI: 10.1291/hypres.27.193. View

Williams T, Mulatero P, Bidlingmaier M, Beuschlein F, Reincke M . Genetic and potential autoimmune triggers of primary aldosteronism. Hypertension. 2015; 66(2):248-53. DOI: 10.1161/HYPERTENSIONAHA.115.05643. View

Hennings J, Andreasson S, Botling J, Hagg A, Sundin A, Hellman P . Long-term effects of surgical correction of adrenal hyperplasia and adenoma causing primary aldosteronism. Langenbecks Arch Surg. 2009; 395(2):133-7. DOI: 10.1007/s00423-009-0498-4. View

Walz M, Gwosdz R, Levin S, Alesina P, Suttorp A, Metz K . Retroperitoneoscopic adrenalectomy in Conn's syndrome caused by adrenal adenomas or nodular hyperplasia. World J Surg. 2008; 32(5):847-53. DOI: 10.1007/s00268-008-9513-0. View

10.

Rutherford J, Taylor W, Stowasser M, Gordon R . Success of surgery for primary aldosteronism judged by residual autonomous aldosterone production. World J Surg. 1998; 22(12):1243-5. DOI: 10.1007/s002689900552. View

11.

Bernini G, Bacca A, Carli V, Carrara D, Materazzi G, Berti P . Cardiovascular changes in patients with primary aldosteronism after surgical or medical treatment. J Endocrinol Invest. 2011; 35(3):274-80. DOI: 10.3275/7611. View

12.

Catena C, Colussi G, Lapenna R, Nadalini E, Chiuch A, Gianfagna P . Long-term cardiac effects of adrenalectomy or mineralocorticoid antagonists in patients with primary aldosteronism. Hypertension. 2007; 50(5):911-8. DOI: 10.1161/HYPERTENSIONAHA.107.095448. View

13.

Horky K, Widimsky Jr J, HRADEC E, GREGOROVA I, Hradec M . Long-term results of surgical and conservative treatment of patients with primary aldosteronism. Exp Clin Endocrinol. 1987; 90(3):337-46. DOI: 10.1055/s-0029-1210710. View

14.

CONN J . Presidential address. I. Painting background. II. Primary aldosteronism, a new clinical syndrome. J Lab Clin Med. 1955; 45(1):3-17. View

15.

Higgins J, Thompson S . Quantifying heterogeneity in a meta-analysis. Stat Med. 2002; 21(11):1539-58. DOI: 10.1002/sim.1186. View

16.

Chioncel V, Paun D, Amuzescu B, Sinescu C . Evolution features of hypertensive patients with primary aldosteronism--prospective study. J Med Life. 2012; 5(3):354-9. PMC: 3465007. View

17.

GROTH H, Vetter W, Stimpel M, Greminger P, Tenschert W, Klaiber E . Adrenalectomy in primary aldosteronism: a long-term follow-up study. Cardiology. 1985; 72 Suppl 1:107-16. DOI: 10.1159/000173955. View

18.

Moher D, Liberati A, Tetzlaff J, Altman D . Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med. 2009; 151(4):264-9, W64. DOI: 10.7326/0003-4819-151-4-200908180-00135. View

19.

Wu V, Huang K, Peng K, Tsai Y, Wu C, Wang S . Prevalence and clinical correlates of somatic mutation in aldosterone producing adenoma-Taiwanese population. Sci Rep. 2015; 5:11396. PMC: 4464349. DOI: 10.1038/srep11396. View

20.

Begg C, Mazumdar M . Operating characteristics of a rank correlation test for publication bias. Biometrics. 1994; 50(4):1088-101. View