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Cited by 43Hormonal Regulation and HypertensionAdrenal and Paraganglionic TumorsAdrenal Hormones and Disorders

Predictors of successful outcome after adrenalectomy for primary aldosteronism

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Wang, Wei, Hu, WeiLie, Zhang, XiaoMing, Wang, BangQi, Bin, Chen, Huang, Hai·2012·International Surgery
DOI 10.9738/cc140.1PMC PMC3723202
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Abstract

The underlying cause of resistant hypertension after adrenalectomy for primary hyperaldosteronism remains controversial. The objective of this study was to identify preoperative factors predictive of resistant hypertension in patients after undergoing retroperitoneoscopic adrenalectomy. Between 2003 and 2009, 124 patients with unilateral aldosterone-producing adenoma or unilateral adrenal hyperplasia underwent retroperitoneoscopic adrenalectomy at our institution. Clinical and biochemical data were reviewed retrospectively at baseline and after a median follow-up time of 59.2 ± 37.2 months. Adrenalectomy cured hypertension in 68 patients (54.8%) and 43 (34.8%) had persistent hypertension that was much easier to control after surgery, whereas 13 patients (10.4%) had continued hypertension and poor blood pressure control. Multivariate regression analysis revealed that the main determinants of postoperative cure were duration of hypertension less than 5 years [odds ratio (OR): 6.515, 95% confidence interval (CI) 2.278-10.293), number of antihypertensive medications ≤2 (OR: 2.939, 95% CI 1.254-5.235), preoperative response to spironolactone (OR: 3.405, 95% CI 1.681-6.985), the TT genotype of the CYP11B2 gene (344 C/T) (OR: 2.765, 95% CI 1.221-4.986), and the presence of adenoma rather than hyperplasia (OR: 5.274, 95% CI 2.150-8.141). The main determinants of surgical cure or control of hypertension in patients with primary hyperaldosteronism were duration of hypertension, number of antihypertensive medications, preoperative response to spironolactone, the presence of adenoma, and CYP11B2 (344 C/T) genotype. Consideration of these factors may help in the evaluation of patients for surgery and for the identification of patients with continued postoperative hypertension that may require more long-term monitoring and treatment.

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  • Older patients and those with longstanding hypertension are more likely to have irreversible vascular damage and persistent hypertension requiring antihypertensive medication despite successful surgery.

    “Older patients and those with longstanding hypertension are more likely to have irreversible vascular damage and have persistent hypertension requiring antihypertensive medication, despite successful surgery (335).”

    From Adrenal incidentaloma (2020) · cites this paper as [335]

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  • Adrenal incidentaloma

    Sherlock, M., Scarsbrook, A., Abbas, A., Fraser, S., Limumpornpetch, P., Dineen, R., & Stewart, P. M. (2020) · Endocrine Reviews · doi:10.1210/endrev/bnaa008 · Cited by 347 · see citing works

    “Older patients and those with longstanding hypertension are more likely to have irreversible vascular damage and have persistent hypertension requiring antihypertensive medication, despite successful surgery (335).”
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Related

Authors
Wang, W., Hu, W., Zhang, X., Wang, B., Bin, C., & Huang, H.
Affiliations
  • General Hospital of Guangzhou Military Command (CN)
  • Department of Urology, Guangzhou General Hospital of Guangzhou Military Command (Guangzhou Liuhuaqiao Hospital), Guangzhou, Guangdong province, China
  • Sun Yat-sen University (CN)
ORCID
Venue
International Surgery
Publisher
International College of Surgeons
Published
2012-10
Volume
97
Issue
2
Pages
104-111
ISSN
  • 0020-8868 (ISSN-L)
  • 2520-2456
DOI
10.9738/cc140.1
PMC
PMC3723202
OpenAlex
W2076941575
Cited by
43
References
32
Citations by year
2024: 1 · 2023: 3 · 2022: 2 · 2021: 5 · 2020: 5 · 2019: 4 · 2018: 2 · 2017: 5 · 2016: 6 · 2015: 6 · 2014: 2 · 2013: 2
FWCI
2.57
Type
journal article
Language
en
Open access
Locations
  • International Surgery (publishedVersion)
  • Europe PMC (PubMed Central) (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hormonal Regulation and Hypertension
  • Health Sciences › Medicine › Surgery › Adrenal and Paraganglionic Tumors
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adrenal Hormones and Disorders
Keywords
primary aldosteronism, adrenalectomy, retroperitoneoscopic adrenalectomy, resistant hypertension, postoperative hypertension, aldosterone-producing adenoma, adrenal hyperplasia, duration of hypertension, antihypertensive medication use, predictors of surgical outcome
MeSH terms
Adenoma, Adrenal Gland Neoplasms, Adrenal Hyperplasia, Congenital, Adrenalectomy, Adult, Decision Support Techniques, Female, Follow-Up Studies, Genetic Markers, Humans, Hyperaldosteronism, Hypertension, Hypokalemia, Male, Middle Aged, Laparoscopy, Retrospective Studies, Multivariate Analysis, Logistic Models, Treatment Outcome, Cytochrome P-450 CYP11B2, Polymorphism, Single Nucleotide, Preoperative Period, Genotyping Techniques

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