Basal Plasma Aldosterone Concentration Predicts Therapeutic Outcomes in Primary Aldosteronism

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Abstract

Purpose

Normal basal plasma aldosterone concentration (PAC) reflects mild aldosterone excess compared to high basal PAC. We previously reported lower risk for cardiovascular and cerebrovascular events in patients with primary aldosteronism (PA) and normal basal PAC (nPA) than in those with high basal PAC (hPA). However, the differences in therapeutic outcomes between nPA and hPA are unclear. The aim of this multi-institutional, retrospective cohort study was to determine the clinical significance of nPA to therapeutic outcomes, including adrenalectomy (ADX) and treatment with mineralocorticoid receptor antagonists (MRAs).

Methods

A total of 1146 patients with PA who were diagnosed and underwent adrenal venous sampling (AVS) between January 2006 and October 2016 were enrolled. The clinical parameters at baseline and after ADX or treatment with MRA were compared between the nPA and hPA groups.

Results

Significantly higher rates of absent clinical success (36.6 vs. 21.9%, P = 0.01) and absent biochemical success (26.4 vs. 5.2%, P < 0.01) were found for the nPA group than for the hPA group, respectively. Logistic regression analysis identified baseline PAC as a significant independent predictor of absent clinical success of ADX and MRAs.

Conclusions

Plasma aldosterone concentration at baseline was a significant and independent predictor of absent clinical success of ADX and MRA. Mineralocorticoid receptor antagonist treatment appeared to be a better therapeutic choice than ADX in the nPA group.

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Most cited references 22

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The Management of Primary Aldosteronism: Case Detection, Diagnosis, and Treatment: An Endocrine Society Clinical Practice Guideline.

John Funder, Robert Carey, Franco Mantero … (2016)

To develop clinical practice guidelines for the management of patients with primary aldosteronism.

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Case detection, diagnosis, and treatment of patients with primary aldosteronism: an endocrine society clinical practice guideline.

John Funder, Robert Carey, Carlos Fardella … (2008)

Our objective was to develop clinical practice guidelines for the diagnosis and treatment of patients with primary aldosteronism. The Task Force comprised a chair, selected by the Clinical Guidelines Subcommittee (CGS) of The Endocrine Society, six additional experts, one methodologist, and a medical writer. The Task Force received no corporate funding or remuneration. Systematic reviews of available evidence were used to formulate the key treatment and prevention recommendations. We used the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) group criteria to describe both the quality of evidence and the strength of recommendations. We used "recommend" for strong recommendations and "suggest" for weak recommendations. Consensus was guided by systematic reviews of evidence and discussions during one group meeting, several conference calls, and multiple e-mail communications. The drafts prepared by the task force with the help of a medical writer were reviewed successively by The Endocrine Society's CGS, Clinical Affairs Core Committee (CACC), and Council. The version approved by the CGS and CACC was placed on The Endocrine Society's Web site for comments by members. At each stage of review, the Task Force received written comments and incorporated needed changes. We recommend case detection of primary aldosteronism be sought in higher risk groups of hypertensive patients and those with hypokalemia by determining the aldosterone-renin ratio under standard conditions and that the condition be confirmed/excluded by one of four commonly used confirmatory tests. We recommend that all patients with primary aldosteronism undergo adrenal computed tomography as the initial study in subtype testing and to exclude adrenocortical carcinoma. We recommend the presence of a unilateral form of primary aldosteronism should be established/excluded by bilateral adrenal venous sampling by an experienced radiologist and, where present, optimally treated by laparoscopic adrenalectomy. We recommend that patients with bilateral adrenal hyperplasia, or those unsuitable for surgery, optimally be treated medically by mineralocorticoid receptor antagonists.

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Outcomes after adrenalectomy for unilateral primary aldosteronism: an international consensus on outcome measures and analysis of remission rates in an international cohort.

Tracy Williams, Jacques Lenders, Paolo Mulatero … (2017)

Although unilateral primary aldosteronism is the most common surgically correctable cause of hypertension, no standard criteria exist to classify surgical outcomes. We aimed to create consensus criteria for clinical and biochemical outcomes and follow-up of adrenalectomy for unilateral primary aldosteronism and apply these criteria to an international cohort to analyse the frequency of remission and identify preoperative determinants of successful outcome.

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Author and article information

Contributors

Michio Otsuki:

ORCID: http://orcid.org/0000-0001-5947-8621

Journal

Journal ID (nlm-ta): J Endocr Soc

Journal ID (iso-abbrev): J Endocr Soc

Journal ID (publisher-id): jes

Title: Journal of the Endocrine Society

Publisher: Oxford University Press (US )

ISSN (Electronic): 2472-1972

Publication date Collection: 01 April 2020

Publication date (Electronic): 13 February 2020

Publication date PMC-release: 13 February 2020

Volume: 4

Issue: 4

Electronic Location Identifier: bvaa011

Affiliations

[1 ] Department of Metabolic Medicine, Osaka University Graduate School of Medicine, Osaka, Japan

[2 ] Department of Endocrinology, Metabolism, and Nephrology, School of Medicine, Keio University, Tokyo, Japan

[3 ] Department of Endocrinology and Metabolism, Saiseikai Yokohamashi Tobu Hospital, Yokohama, Japan

[4 ] Department of Internal Medicine, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan

[5 ] Division of Metabolism and Endocrinology, Department of Internal Medicine, St. Marianna University School of Medicine, Yokohama City Seibu Hospital, Yokohama, Japan

[6 ] Department of Endocrinology and Metabolism, National Hospital Organization Kyoto Medical Center, Kyoto, Japan

[7 ] Department of Diabetes and Endocrinology, Sapporo City General Hospital, Sapporo, Japan

[8 ] Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences , Kyushu University, Fukuoka, Japan

[9 ] Department of Metabolic Medicine, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan

[10 ] Department of Diabetes, Endocrinology, and Nutrition, Kyoto University, Kyoto, Japan

[11 ] Department of Molecular Endocrinology and Metabolism, Tokyo Medical and Dental University, Tokyo, Japan

[12 ] Department of Diabetes and Endocrinology, Tokyo Metropolitan Hiroo Hospital, Tokyo, Japan

[13 ] Department of Cardiology, Mie University Hospital, Mie, Japan

[14 ] Division of Metabolism, Showa General Hospital, Tokyo, Japan

[15 ] Division of Nephrology, Hypertension, and Endocrinology, Nihon University School of Medicine , Tokyo, Japan

[16 ] Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan

[17 ] Department of Cardiology, Shinko Hospital, Kobe, Japan

[18 ] Department of Geriatric and General Medicine, Osaka University Graduate School of Medicine, Osaka, Japan

[19 ] Department of Endocrinology and Metabolism, Tottori University Hospital, Yonago, Japan

[20 ] Department of Internal Medicine, Division of Diabetes, Endocrinology and Clinical Immunology, Hyogo College of Medicine , Hyogo, Japan

[21 ] Department of Medicine and Molecular Science, Gunma University Graduate School of Medicine , Maebashi, Japan

[22 ] Division of Endocrinology, National Center for Global Health and Medicine , Tokyo, Japan

[23 ] Endocrine Center, Ijinkai Takeda General Hospital , Kyoto, Japan

Author notes

Correspondence: Michio Otsuki, MD, PhD, Department of Metabolic Medicine, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka 565–0871, Japan. Phone: +81-6-6879-3732. Fax: +81-6-6879-3739. E-mail: otsuki@ 123456endmet.med.osaka-u.ac.jp .

Author information

Michio Otsuki http://orcid.org/0000-0001-5947-8621

Nobuya Inagaki http://orcid.org/0000-0001-8261-2593

Ryuji Okamoto http://orcid.org/0000-0002-8067-398X

Kouichi Tamura http://orcid.org/0000-0002-0660-5372

Article

Publisher ID: bvaa011

DOI: 10.1210/jendso/bvaa011

PMC ID: 7067551

SO-VID: bd63e11b-8e6b-4bba-a4f9-cb53d80b61ff

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence ( http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com

History

Date received : 21 December 2019

Date accepted : 10 February 2020

Date: 24 January 2020

Date: 12 March 2020

Page count

Pages: 12

Funding

Funded by: Japan Agency for Medical Research and Development, DOI 10.13039/100009619;

Award ID: #JP17ek0109112

Award ID: JP19ek0109352

Funded by: National Center for Global Health and Medicine, Japan;

Award ID: #27–1402

Award ID: 30–1008

Funded by: Health Labour Sciences Research Grant;

Funded by: Ministry of Health, Labor and Welfare, Japan;

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Basal Plasma Aldosterone Concentration Predicts Therapeutic Outcomes in Primary Aldosteronism

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cGMP: Generators, Effectors and Therapeutic Implications Conference

Most cited references 22

The Management of Primary Aldosteronism: Case Detection, Diagnosis, and Treatment: An Endocrine Society Clinical Practice Guideline.

Case detection, diagnosis, and treatment of patients with primary aldosteronism: an endocrine society clinical practice guideline.

Outcomes after adrenalectomy for unilateral primary aldosteronism: an international consensus on outcome measures and analysis of remission rates in an international cohort.

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Cited by 7

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