Predictors of clinical and biochemical success of adrenalectomy in patients with unilateral primary aldosteronism

Objective: Our study aimed to evaluate clinical and laboratory predictors of outcome of unilateral adrenalectomy in patients with primary aldosteronism (PA). Design and method: Data from patients with unilateral PA verified by adrenal venous sampling who subsequently underwent transperitoneal laparoscopic adrenalectomy between 2008 and 2019 were analyzed. We assessed patient demographics, preoperative and postoperative clinical, pharmacological, laboratory, and radiological data. Antihypertensive drug use was quantified by estimating the daily defined dose (DDD) of antihypertensive medication. Statistical assessments included univariable and multivariable logistic regression analysis. Results: 87 patients with PA were enrolled. Complete biochemical success of surgery, defined as normalisation of the aldosterone-to-renin ratio and correction of hypokalaemia, was reached in 67 patients (77%), 19 patients (22%) had partial biochemical success (please see the Figure). Complete clinical success with normalization of blood pressure and withdrawal of all antihypertensive drugs was achieved in 19 patients (22%). 57 patients (65%) exhibited a reduction of DDD after surgery and/or improvement of blood pressure - partial clinical success. Multivariable logistic regression showed that complete clinical success was independently associated with female gender (odds ratio: OR 3.71, 95% CI 1.16–11.87, P = 0.027) and baseline sum of antihypertensive drugs DDD < 4 (OR 5.30, 95% CI 1.68–16.67, P = 0.004). None of the analysed clinical or laboratory parameters was found to be a significant predictor of biochemical success. Conclusion: A majority of patients undergoing unilateral adrenalectomy for PA achieved markedly improved hypertension control while almost halving their antihypertensive medication. Females and patients using lower number of antihypertensive drugs preoperatively were more likely to be completely cured by the surgery.