Prognosis of primary aldosteronism achieved incomplete surgical remissionand changes in plasma aldosterone, plasma renin activity and biochemical indicators
changes in plasma aldosterone, plasma renin activity in primary aldosteronism
Abstract
Background and Purpose: Some primary aldosteronism (PA) patients with spontaneous hypokalemia achieved incomplete remission after surgical treatment. In this study, we aim to construct a nomogram to predict surgical benefits for PA patients with typical symptoms, which may help doctors assess prognosis and develop treatment plans.
Methods: This retrospective cohort study enrolled 162 patients between January 2017 and January 2024. Baseline characteristics, clinical indicators, and biochemical results 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: Respectively, complete clinical and biochemical success was achieved in 69 patients (42.6%) and 129 patients (79.6%). Five risk factors for incomplete remission 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 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 to achieve incomplete remission after the surgery.
References
2. Mosso L, Carvajal C, González A, Barraza A, Avila F, Montero J, et al. Primary aldosteronism and hypertensive disease. Hypertension 2003;42(2):161-5.
3. Monticone S, D’Ascenzo F, Moretti C, Williams TA, Veglio F, Gaita F, et al. Cardiovascular events and target organ damage in primary aldosteronism compared with essential hypertension: a systematic review and meta-analysis. Lancet Diabetes Endocrinol 2018;6(1):41–50.
4. Mulatero P, Stowasser M, Loh KC, Fardella CE, Gordon RD, Mosso L, et al. Increased diagnosis of primary aldosteronism, including surgically correctable forms, in centers from five continents. J Clin Endocrinol Metab 2004;89(3):1045–50.
5. Burrello J, Monticone S, Losano I, Cavaglià G, Buffolo F, Tetti M, et al. Prevalence of Hypokalemia and Primary Aldosteronism in 5100 Patients Referred to a Tertiary Hypertension Unit. Hypertens Dallas Tex 1979 2020;75(4):1025–33.
6. Funder JW, Carey RM, Mantero F, Murad MH, Reincke M, Shibata H, et al. The Management of Primary Aldosteronism: Case Detection, Diagnosis, and Treatment: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab 2016;101(5):1889–916.
7. Zhang M, Bian G, Tian J, Yang W, Wang X, Chi C. Assessment of biochemical outcomes in patients with primary aldosteronism after adrenalectomy based on CT scan diagnosis of unilateral adenoma without adrenal vein sampling. Front Oncol 2022;12:944035.
8. Dekkers T, Prejbisz A, Kool LJS, Groenewoud HJMM, Velema M, Spiering W, et al. Adrenal vein sampling versus CT scan to determine treatment in primary aldosteronism: an outcome-based randomised diagnostic trial. Lancet Diabetes Endocrinol 2016;4(9):739–46.
9. Williams TA, Lenders JWM, Mulatero P, Burrello J, Rottenkolber M, Adolf C, et al. Outcomes after adrenalectomy for unilateral primary aldosteronism: an international consensus on outcome measures and analysis of remission rates in an international cohort. Lancet Diabetes Endocrinol 2017;5(9):689–99.
10. Mancia G, Fagard R, Narkiewicz K, Redon J, Zanchetti A, Böhm M, et al. 2013 ESH/ESC guidelines for the management of arterial hypertension: the Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Eur Heart J 2013;34(28):2159–219.
11. Sawka AM, Young WF, Thompson GB, Grant CS, Farley DR, Leibson C, et al. Primary aldosteronism: factors associated with normalization of blood pressure after surgery. Ann Intern Med 2001;135(4):258–61.
12. Sowers JR, Whaley-Connell A, Epstein M. Narrative review: the emerging clinical implications of the role of aldosterone in the metabolic syndrome and resistant hypertension. Ann Intern Med 2009;150(11):776-83.
13. Wada N, Shibayama Y, Yoneda T, Katabami T, Kurihara I, Tsuiki M, et al. Lateralizing Asymmetry of Adrenal Imaging and Adrenal Vein Sampling in Patients With Primary Aldosteronism. J Endocr Soc 2019;3(7):1393–402.
14. Otsuka H, Abe M, Kobayashi H. The Effect of Aldosterone on Cardiorenal and Metabolic Systems. Int J Mol Sci 2023;24(6):5370.
Copyright (c) 2025 Xiaoyong Zeng
This work is licensed under a Creative Commons Attribution 4.0 International License.
The published articles will be distributed under the Creative Commons Attribution 4.0 International License (CC BY). It is allowed to copy and redistribute the material in any medium or format, and remix, transform, and build upon it for any purpose, even commercially, as long as appropriate credit is given to the original author(s), a link to the license is provided and it is indicated if changes were made. Users are required to provide full bibliographic description of the original publication (authors, article title, journal title, volume, issue, pages), as well as its DOI code. In electronic publishing, users are also required to link the content with both the original article published in Journal of Medical Biochemistry and the licence used.
Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.