Department of Urology, University of Medicine of Tunis, Charles Nicolle Hospital, Tunis, Tunisia.
Department of Endocrinology, University of Medicine of Tunis, Charles Nicolle Hospital, Tunis, Tunisia.
Front Endocrinol (Lausanne). 2023 Aug 11;14:1205988. doi: 10.3389/fendo.2023.1205988. eCollection 2023.
Unilateral primary aldosteronism (UPA) is the most frequent surgically curable form of endocrine hypertension. Adrenalectomy is the cornerstone of treatment for UPA, but outcomes after surgery are variable. The cause of resistant hypertension after surgery is still a matter of debate. Our aim was to investigate cure rates after surgery and to evaluate preoperative factors that might influence the surgical outcome.
Between 2000 and 2021, the charts of 71 Tunisian patients who underwent laparoscopic adrenalectomy for UPA were retrospectively reviewed. Preoperative medical records were collected and follow-up data (1-158 months) were registered. Antihypertensive medication doses were calculated using defined daily doses (DDD) and postoperative outcomes were assessed using the Primary Aldosteronism Surgical Outcome (PASO) criterion.
Of 91 enrolled patients, 71 (59% women, mean age 46 years, median length of follow-up 21 months) were suitable for evaluation. Thirty-four patients (48%) had complete clinical success according to the PASO criteria. The most relevant factors associated with complete clinical success on univariate analysis were: absence of diabetes (p= 0.007), low body mass index (BMI) (p= 0.001), lower preoperative DDD (p= 0.01), preoperatively controlled blood pressure (p= 0.024), higher plasma aldosterone to renin ratio (ARR) (p= 0.001), adenoma subtyping (p <0.001) and aldosteronoma resolution score (ARS) (p= 0.002). Multivariate regression analysis showed that the major predictors of complete clinical success were absence of diabetes (OR: 5.205), a BMI < 30 (OR: 4.930), a plasma ARR > 332 (OR: 4.554) and an ARS ≥ 3 (OR: 2.056).
Complete and partial clinical response rates were achieved in respectively 48 and 43% of cases. The main predictors of complete resolution of hypertension were absence of diabetes, low BMI, high plasma ARR and high ARS. Taking these factors into account may help identify patients at risk of persistent postoperative hypertension who may require long-term surveillance and medication.
单侧原发性醛固酮增多症（UPA）是最常见的可通过手术治愈的内分泌性高血压。肾上腺切除术是治疗 UPA 的基石，但手术后的结果是可变的。手术后高血压抵抗的原因仍存在争议。我们的目的是研究手术后的治愈率，并评估可能影响手术结果的术前因素。
在 2000 年至 2021 年间，对 71 例接受腹腔镜肾上腺切除术治疗 UPA 的突尼斯患者的病历进行了回顾性分析。收集了术前的病历记录，并登记了随访数据（1-158 个月）。使用定义日剂量（DDD）计算了抗高血压药物剂量，并使用原发性醛固酮增多症手术结果（PASO）标准评估了术后结果。
在纳入的 91 例患者中，有 71 例（59%为女性，平均年龄 46 岁，中位随访时间 21 个月）适合进行评估。34 例（48%）根据 PASO 标准完全达到临床缓解。单因素分析中与完全临床缓解最相关的因素包括：无糖尿病（p=0.007）、低体重指数（BMI）（p=0.001）、较低的术前 DDD（p=0.01）、术前血压控制良好（p=0.024）、较高的血浆醛固酮与肾素比值（ARR）（p=0.001）、腺瘤亚型（p<0.001）和醛固酮瘤缓解评分（ARS）（p=0.002）。多因素回归分析显示，完全临床缓解的主要预测因素是无糖尿病（OR：5.205）、BMI<30（OR：4.930）、血浆 ARR>332（OR：4.554）和 ARS≥3（OR：2.056）。
分别有 48%和 43%的患者达到完全和部分临床缓解。高血压完全缓解的主要预测因素是无糖尿病、低 BMI、高血浆 ARR 和高 ARS。考虑这些因素可能有助于识别术后高血压持续存在风险的患者，这些患者可能需要长期监测和药物治疗。
