Basal plasma aldosterone predicts therapeutic outcomes in primary aldosteronism
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Baseline plasma aldosterone concentration is independently associated with clinical and biochemical outcomes of treatment among adults with primary aldosteronism, and data suggest that mineralocorticoid receptor antagonist therapy is the optimal strategy vs. adrenalectomy for those with a normal plasma aldosterone concentration, according to findings published in the Journal of the Endocrine Society.
“In this study, we have demonstrated the importance of plasma aldosterone concentration at baseline as a predictor of clinical and biochemical success, as assessed by the international consensus criteria for adrenalectomy and mineralocorticoid receptor antagonist treatment,” Michio Otsuki, MD, PhD, associate professor in the department of metabolic medicine at Osaka University Graduate School of Medicine in Osaka, Japan, told Healio. “The take-home message of our research is that a normal basal plasma aldosterone concentration is different from a high basal plasma aldosterone concentration (typical primary aldosteronism) with respect to therapeutic outcomes. Plasma aldosterone concentration at baseline should be considered when assessing therapeutic strategies for adults with primary aldosteronism.”
In a retrospective, cross-sectional study, Otsuki and colleagues analyzed data from 1,146 adults with primary aldosteronism (diagnosed according to Japan Endocrine Society guidelines) who underwent adrenal venous sampling between January 2006 and October 2016, using data from the Japan Primary Aldosteronism Study. Patients also underwent adrenalectomy (n = 349) or received mineralocorticoid receptor antagonist therapy (n = 797). Researchers stratified patients by normal (n = 601) and high plasma aldosterone concentration (n = 545) and then compared clinical parameters at baseline and 1 year after adrenalectomy or mineralocorticoid receptor antagonist therapy between the two groups.
Compared with those who had a high plasma aldosterone concentration, patients with a normal plasma aldosterone concentration were older (mean, 56 vs. 52 years; P < .01), were less likely to be men (44.9% vs. 52.8%; P < .01) and had a shorter duration of hypertension (mean, 4 vs. 8 years; P < .01). Those with a normal plasma aldosterone concentration also had fewer adrenal masses discovered via CT scan when compared with those with a high plasma aldosterone concentration (33% vs. 59.1%; P < .01).
Using international consensus criteria, researchers found that the rate of absent clinical success after adrenalectomy was higher among adults with a normal baseline plasma aldosterone concentration vs. those with a high plasma aldosterone concentration (36.6% vs. 21.9%; P = .01). Results were similar for absent biochemical success after surgery among adults in the normal vs. high plasma aldosterone groups (26.4% vs. 5.2%; P < .01).
When comparing outcomes after mineralocorticoid receptor antagonist therapy, researchers found that diastolic blood pressure and prevalence of posttherapy hypokalemia were lower among adults in the normal plasma aldosterone concentration group compared with the high plasma aldosterone group (P < .01 for both).
In logistic regression analysis, baseline plasma aldosterone concentration was an independent predictor of absent clinical success of surgery and mineralocorticoid receptor antagonist therapy.
“The results also showed that mineralocorticoid receptor antagonist treatment may be a better therapeutic strategy with regards to clinical outcome than adrenalectomy in patients with normal basal plasma aldosterone concentration,” the researchers wrote. – by Regina Schaffer
For more information:
Michio Otsuki, MD, PhD, can be reached at the Department of Internal Medicine (Metabolic Medicine), Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka 565-0871, Japan; email: otsuki@endmet.med.osaka-u.ac.jp.
Disclosures: The authors report no relevant financial disclosures.
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