Goldbaum Tatiana S, Ledesma Felipe L, Guimaraes Augusto G, Okubo Jessica, Kawahara Eduardo Z, Calsavara Vinicius F, Bortolotto Luiz A, Chambo Jose L, Fragoso Maria Candida B V, Pereira Maria Adelaide A, Pio-Abreu Andrea, Silva Giovanio V, Silveira João V, Consolim-Colombo Fernanda M, Drager Luciano F, Nahas William C, Latronico Ana Claudia, Mendonca Berenice B, Almeida Madson Q, Zerbini Maria Claudia N
Unidade de Adrenal, Laboratório de Endocrinologia Molecular e Celular LIM25, Divisão de Endocrinologia e Metabologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo 01246-903, Brasil.
Departamento de Patologia, Faculdade de Medicina da Universidade de São Paulo, São Paulo 01246-903, Brasil.
Eur J Endocrinol. 2025 May 30;192(6):763-775. doi: 10.1093/ejendo/lvaf118.
The utility of histopathological classification based on aldosterone synthase (CYP11B2) immunostaining in unilateral primary aldosteronism (PA) for predicting clinical and biochemical outcomes after adrenalectomy remains controversial.
We conducted a cohort study involving 131 consecutive patients with unilateral PA who underwent unilateral adrenalectomy. Aldosterone-producing adrenal lesions were classified according to the HISTALDO criteria. Biochemical and clinical outcomes were assessed using the PASO criteria.
Among the 131 adrenal lesions, classical and non-classical histology were identified in 101 (77.09%) and 30 (22.91%) cases, respectively. In the classical group, 89 cases were classified as aldosterone-producing adenoma (APA), and 12 as aldosterone-producing nodule (APN). Within the non-classical group, 27 cases (90%) had multiple aldosterone-producing micronodules, and 3 cases (30%) had multiple APNs. Patients with classical histology were younger (P = .028) and predominantly female (P = .028) compared to those with non-classical histology. Classical histology was associated with higher rates of complete biochemical success (97.03% vs 68.97%, P < .001) and complete hypertension remission (34.34% vs 10.71%, P < .001) compared to non-classical histology. Although clinical and biochemical outcomes were similar between APA and APN, their immunohistological characteristics differed (fewer clear cells and stronger CYP11B2 staining in APN). In multivariable analysis, classical histology remained independently associated with complete biochemical (P < .001) and clinical (P = .037) success.
Classical histology was an independent variable associated with more severe PA, complete biochemical and hypertension remission in surgically treated patients with unilateral PA. Moreover, the distinction between APA and APN did not differentiate outcome.
基于醛固酮合酶（CYP11B2）免疫染色的组织病理学分类在单侧原发性醛固酮增多症（PA）中用于预测肾上腺切除术后的临床和生化结果，其效用仍存在争议。
我们进行了一项队列研究，纳入了131例连续接受单侧肾上腺切除术的单侧PA患者。根据HISTALDO标准对产生醛固酮的肾上腺病变进行分类。使用PASO标准评估生化和临床结果。
在131个肾上腺病变中，分别在101例（77.09%）和30例（22.91%）中发现了经典和非经典组织学。在经典组中，89例被分类为醛固酮瘤（APA），12例为醛固酮结节（APN）。在非经典组中，27例（90%）有多个产生醛固酮的微结节，3例（30%）有多个APN。与非经典组织学的患者相比，经典组织学的患者更年轻（P = 0.028）且以女性为主（P = 0.028）。与非经典组织学相比，经典组织学与更高的完全生化成功发生率（97.03%对68.97%，P < 0.001）和完全高血压缓解率（34.34%对10.71%，P < 0.001）相关。尽管APA和APN之间的临床和生化结果相似，但它们的免疫组织学特征不同（APN中透明细胞较少且CYP11B2染色较强）。在多变量分析中，经典组织学仍然与完全生化（P < 0.001）和临床（P = 0.037）成功独立相关。
经典组织学是一个独立变量，与手术治疗的单侧PA患者中更严重的PA、完全生化和高血压缓解相关。此外，APA和APN之间的区别并不能区分结果。
