Adequate timing key for biochemical evaluation after unilateral adrenalectomy
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A biochemical evaluation to determine the success of unilateral adrenalectomy among adults with an aldosterone-producing adenoma should occur no sooner than 3 months after surgery, due in part to early postsurgical changes in active renin concentration, according to findings published in Clinical Endocrinology.
“The appropriate timing for a biochemical evaluation of unilateral aldosterone-producing adenoma patients treated with adrenalectomy appears to be 3 months or more after surgery,” Kimiharu Takamatsu, MD, associate professor in the department of urology at Keio University School of Medicine in Tokyo, told Healio. “The normalization of renin secretion could require 3 months, especially among patients with severe renin-suppression before surgery.”
Takamatsu and colleagues analyzed data from 166 adults diagnosed with an aldosterone-producing adenoma who underwent laparoscopic adrenalectomy between 2001 and 2017 at Keio University Hospital (median age, 53 years; 43% women; median BMI, 23.3 kg/m²). Researchers assessed plasma aldosterone concentration, active renin concentration, aldosterone-to-renin ratio, serum potassium concentration and estimated glomerular filtration rate at 1, 3 and 6 months after surgery. Biochemical outcomes were based on Primary Aldosteronism Surgical Outcome criteria, with complete biochemical success defined as normalization of serum potassium and aldosterone-to-renin ratio. Partial biochemical success was defined as normalization of serum potassium and elevated aldosterone-to-renin ratio with more than a 50% decrease in plasma aldosterone concentration from presurgery level. Absent biochemical success was defined as persistent hypokalemia and/or persistently elevated aldosterone-to-renin ratio with the failure to suppress aldosterone secretion via confirmatory testing after surgery.
Within the cohort, 10% of participants had diabetes and 7% had cardiovascular disease.
Researchers found that plasma aldosterone concentration was lower at 1 month after surgery vs. presurgery (mean, 90 pg/mL vs. 407.2 pg/mL; P < .001). Active renin concentration did not increase for the cohort between baseline and 1 month after surgery (mean, 4.43 pg/mL vs. 4.87 pg/mL); however, researchers observed a rise at 3 months after surgery (mean, 11.3 pg/mL; P < .001).
Aldosterone-to-renin ratio decreased for the cohort between baseline and 1 month after surgery (mean, 146.9 vs. 26.3; P < .001).
Among 34 participants with hypokalemia before surgery, 28 (82%) experienced resolution at 1 month after surgery, and all were resolved by 3 months after surgery.
At 1 month after surgery, 79% had complete biochemical success, 12% had partial biochemical success and 9% had absent biochemical success. At 3 months after surgery, 89%, 5% and 6% had complete, partial and absent biochemical success, respectively.
Between 1 and 3 months after surgery, 14 participants were reclassified from partial to complete biochemical success, five from absent to complete success and one from absent to partial success. During the same period, two participants were reclassified from complete to partial success and one from partial to absent success.
“The mechanism of hormonal change after adrenalectomy for unilateral aldosterone-producing adenoma is still unclear,” Takamatsu said. “A study including the confirmatory tests, such as saline infusion test, and 24-hour urinary Na/K data after surgery as parameters for systemic volume change is needed for understanding the mechanism of hormonal change.” – by Regina Schaffer
For more information:
Kimiharu Takamatsu, MD, can be reached at Keio University School of Medicine, Department of Urology, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582; email: kimiharutakamatsu@gmail.com.
Disclosures: Two authors report they have received honoraria from Bristol-Myers Squibb, Novartis and Pfizer. Takamatsu reports no relevant financial disclosures.
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