Citton Marilisa, Viel Giovanni, Torresan Francesca, Rossi Gian Paolo, Iacobone Maurizio
Endocrine Surgery, Department of Surgery, Oncology and Gastroenterology, University of Padua, Via Giustiniani 2, 35128, Padova, Italy.
Hypertension Clinic, Department of Medicine, University of Padua, Via Giustiniani 2, 35128, Padova, Italy.
BMC Surg. 2019 Apr 24;18(Suppl 1):105. doi: 10.1186/s12893-018-0432-1.
Primary aldosteronism (PA) is associated with an increased prevalence of anxiety and depression. Subnormal quality of life (QoL) scores in PA patients may be improved after surgical treatment. The aim of the study was to assess the impact of surgery on health-related QoL and depression status of patients suffering from PA, comparing the results with a control group of patients undergoing surgery for non-secreting adrenal tumors.
Data on QoL and depression status were prospectively collected, from January 2014 to January 2017, before, early after surgery (at 1 month) and at late follow up (at least 6 months) in patients with unilateral PA and in a control group with non-secreting adrenal tumors submitted to unilateral laparoscopic adrenalectomy. QoL was assessed using the Short Form 36 (SF-36) Health Survey for Physical (PCS) and Mental Component (MCS); the depression status by a 20-item depression scale (DS) questionnaire.
Twenty-six PA patients and 15 controls were recruited. Biochemical cure of the disease was achieved following surgery in all PA patients; hypertension was cured in 31% of cases and improved in the remaining 69% of cases. No morbidity occurred in both groups. There were no significant differences between PA patients and controls concerning demographics, preoperative PCS, MCS and DS values. In patients with PA, MCS values improved at early (42.72 ± 13.68 vs 51.56 ± 9.03, p = 0.0005) and late follow up (42.72 ± 13.68 vs 51.81 ± 7.04, p < 0.0001); also DS values improved at early (15.92 ± 11.98 vs 8.3 ± 8.8, p = 0.0002) and late follow up (15.92 ± 11.98 vs 4.57 ± 6.11, p < 0.0001). In PA patients PCS values significantly improved at late follow up (51.02 ± 8.04 vs 55.85 ± 5.1, p = 0.013). Also in controls an improvement of MCS and DS scores was found at early and late follow up compared to preoperative values, while no significant differences in PCS were found.
Both PA and non-secreting adrenal tumors affect health-related QoL, worsening MCS and DS scores. Adrenalectomy is effective in curing PA, and improving MCS and DS scores at early and late follow-up, in patients with PA and non-secreting adrenal tumors. In PA patient surgery also significantly improves PCS at late follow up.
原发性醛固酮增多症（PA）与焦虑和抑郁的患病率增加有关。PA患者生活质量（QoL）评分低于正常水平，手术治疗后可能会得到改善。本研究的目的是评估手术对PA患者健康相关生活质量和抑郁状态的影响，并将结果与接受非分泌性肾上腺肿瘤手术的对照组患者进行比较。
前瞻性收集2014年1月至2017年1月期间单侧PA患者和接受单侧腹腔镜肾上腺切除术的非分泌性肾上腺肿瘤对照组患者术前、术后早期（1个月）和晚期随访（至少6个月）的QoL和抑郁状态数据。使用简短健康调查问卷36项（SF-36）评估身体（PCS）和心理成分（MCS）的生活质量；通过20项抑郁量表（DS）问卷评估抑郁状态。
招募了26例PA患者和15例对照。所有PA患者术后疾病均实现生化治愈；31%的病例高血压得到治愈，其余69%的病例有所改善。两组均未发生并发症。PA患者和对照组在人口统计学、术前PCS、MCS和DS值方面无显著差异。在PA患者中，MCS值在早期（42.72±13.68 vs 51.56±9.03，p = 0.0005）和晚期随访（42.72±13.68 vs 51.81±7.04，p < 0.0001）时有所改善；DS值在早期（15.92±11.98 vs 8.3±8.8，p = 0.0002）和晚期随访（15.92±11.98 vs 4.57±6.11，p < 0.0001）时也有所改善。在PA患者中，PCS值在晚期随访时显著改善（51.02±8.04 vs 55.85±5.1，p = 0.013）。在对照组中，与术前值相比，早期和晚期随访时MCS和DS评分也有所改善，而PCS无显著差异。
PA和非分泌性肾上腺肿瘤均会影响健康相关生活质量，使MCS和DS评分恶化。肾上腺切除术对治愈PA有效，并且在PA患者和非分泌性肾上腺肿瘤患者的早期和晚期随访中可改善MCS和DS评分。对于PA患者，手术在晚期随访时也能显著改善PCS。
