Miller B S, Turcu A F, Nanba A T, Hughes D T, Cohen M S, Gauger P G, Auchus R J
Division of Endocrine Surgery, Section of General Surgery, Department of Surgery, University of Michigan, 2920 Taubman Center, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA.
Division of Metabolism, Endocrinology, and Diabetes, University of Michigan, Ann Arbor, MI, USA.
World J Surg. 2018 Feb;42(2):453-463. doi: 10.1007/s00268-017-4311-1.
Determination of outcomes after adrenalectomy for primary aldosteronism (PA) is limited by the lack of standardized definitions of cure. The Primary Aldosteronism Surgical Outcomes (PASO) group recently established new consensus definitions for biochemical and clinical cure of PA. We hypothesize that utilization of PASO definitions will better stratify patient outcomes after surgery compared to original and current criteria utilized to document cure.
Patients undergoing adrenalectomy for PA from 1996 to 2016 were studied. Clinical data were reviewed. Three different sets of criteria (original, current, and PASO) were evaluated for differences in documentation of cure. Demographic data were reported as median (range). Comparisons were made using the Mann-Whitney U test; p < 0.05 is significant.
A total of 314 patients with PA were identified. Ninety patients (60 males) elected to proceed with surgery. In Group 1 (35 patients), 30 patients had clinical follow-up and 29 (97%) were cured using original criteria. In Group 2 (55 patients), cure was recorded in 98% when original criteria for cure were applied, 89% cured applying current criteria, and 6% had complete biochemical and clinical cure by PASO criteria. Aldosterone rose 3.6 ng/dL (0.1-34.8) in five patients during extended follow-up, with two patients changing from complete to partial or missing biochemical success.
Significant heterogeneity exists in outcomes criteria utilized to document cure or clinical improvement after adrenalectomy for primary aldosteronism. Aldosterone levels change over time after adrenalectomy. PASO definitions of cure appear to allow for improved stratification of short- and long-term outcomes.
原发性醛固酮增多症（PA）肾上腺切除术后结局的判定因缺乏治愈的标准化定义而受到限制。原发性醛固酮增多症手术结局（PASO）小组最近为PA的生化和临床治愈制定了新的共识定义。我们假设，与用于记录治愈情况的原始标准和当前标准相比，采用PASO定义将能更好地对患者术后结局进行分层。
对1996年至2016年因PA接受肾上腺切除术的患者进行研究。回顾临床资料。评估了三组不同的标准（原始标准、当前标准和PASO标准）在治愈记录方面的差异。人口统计学数据以中位数（范围）报告。采用Mann-Whitney U检验进行比较；p < 0.05具有统计学意义。
共识别出314例PA患者。90例患者（60例男性）选择进行手术。在第1组（35例患者）中，30例患者进行了临床随访，按照原始标准29例（97%）治愈。在第2组（55例患者）中，应用原始治愈标准时98%记录为治愈，应用当前标准时89%治愈，而按照PASO标准6%实现了完全生化和临床治愈。5例患者在延长随访期间醛固酮升高3.6 ng/dL（0.1 - 34.8），2例患者从完全生化成功转变为部分成功或生化成功缺失。
用于记录原发性醛固酮增多症肾上腺切除术后治愈或临床改善情况的结局标准存在显著异质性。肾上腺切除术后醛固酮水平随时间变化。PASO治愈定义似乎有助于更好地对短期和长期结局进行分层。
