Lee Tsae-Ni, Chang Chin-Chen, Chueh Jeff S, Tseng Chi-Shin, Wu Vin-Cent, Peng Kang-Yung, Yang Po-Lung, Wang Shuo-Meng
Department of Urology, National Taiwan University Hospital, Taipei, Taiwan.
Department of Radiology, National Taiwan University Hospital, Taipei, Taiwan.
Hypertens Res. 2025 May;48(5):1739-1748. doi: 10.1038/s41440-025-02101-6. Epub 2025 Mar 3.
Primary aldosteronism (PA) is the most common secondary hypertension. The best treatment for a lateralized PA is unilateral adrenalectomy. Recent studies explored partial adrenalectomy (pAdx) to reduce the risk of adrenal insufficiency. However, in cases involving multiple aldosterone-producing micronodules/nodules (mAPM/mAPN), pAdx cannot completely remove all origins of excess aldosterone and might not resolve hypertension. CYP11B2 immunohistochemical staining helps HISTALDO (Histopathology of PA) diagnosis, and adrenal specimens were categorized into various groups accordingly. To determine whether pAdx should be considered for lateralized PA, we focused on the success rate of classical (black + grey group) versus non-classical (white group) lateralized PA, and the percentage of co-existing mAPM/mAPN in lateralized PA. The visible tumor in imaging could be either non-functional (incidentaloma; white group), or with concurrent surrounding mAPM/mAPN (grey group) causing hypertension. Among 445 patients who underwent unilateral adrenalectomy, 390 were diagnosed with lateralized PA. There were 63 (30.73%) in the black, 79 (38.54%) in the grey, 63 (30.73%) in the white group. The overall complete clinical success rate was 51.28% in our lateralized PA patients; with 65.08% in the black, 50.63% in the grey, and 26.98% in the white group. The overall partial clinical success rate was 38.54%; with 28.57% in the black, 34.18% in the grey, and 53.97% in the white group. Were pAdx performed, significantly lower success rates would be achieved, especially for lateralized PA patients of the grey and white groups. We speculate that unilateral pAdx is not an appropriate option for the majority of lateralized PA patients. Our results show that unilateral partial adrenalectomy is not a good surgical option for the majority of lateralized PA patients. In clinically lateralized PA patients, no matter which group they are in the HISTALDO classification, they would benefit from unilateral total adrenalectomy.
原发性醛固酮增多症（PA）是最常见的继发性高血压。对于单侧PA，最佳治疗方法是单侧肾上腺切除术。最近的研究探索了部分肾上腺切除术（pAdx）以降低肾上腺功能不全的风险。然而，在涉及多个产生醛固酮的微结节/结节（mAPM/mAPN）的病例中，pAdx无法完全消除所有过量醛固酮的来源，可能无法解决高血压问题。CYP11B2免疫组织化学染色有助于PA的组织病理学（HISTALDO）诊断，肾上腺标本据此被分为不同组。为了确定单侧PA是否应考虑行pAdx，我们关注经典型（黑+灰组）与非经典型（白组）单侧PA的成功率，以及单侧PA中共存mAPM/mAPN的百分比。影像学上可见的肿瘤可能是非功能性的（偶发瘤；白组），或者伴有并发的周围mAPM/mAPN（灰组）导致高血压。在445例行单侧肾上腺切除术的患者中，390例被诊断为单侧PA。黑组63例（30.73%），灰组79例（38.54%），白组63例（30.73%）。我们单侧PA患者的总体临床完全成功率为51.28%；黑组为65.08%，灰组为50.63%，白组为26.98%。总体部分临床成功率为38.54%；黑组为28.57%，灰组为34.18%，白组为53.97%。若行pAdx，成功率将显著降低，尤其是灰组和白组的单侧PA患者。我们推测单侧pAdx对大多数单侧PA患者不是一个合适的选择。我们的结果表明，单侧部分肾上腺切除术对大多数单侧PA患者不是一个好的手术选择。在临床单侧PA患者中，无论他们在HISTALDO分类中属于哪一组，单侧全肾上腺切除术都会使他们受益。
