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Surgical treatment outcome of primary aldosteronism assessed using new modified diagnostic tests

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Abstract

Purpose

Primary aldosteronism (PA) is the most frequent type of endocrine hypertension. In our previous studies, we introduced two modified diagnostic tests for PA, the post-dexamethasone saline infusion test (DSIT) and the overnight dexamethasone, captopril, and valsartan test (DCVT). In this study, we aimed to validate both tests in respect to the biochemical and clinical response of a cohort of hypertensive patients in pre- and post-surgical setting.

Methods

We retrospectively studied 41 hypertensive patients (16 males), with a median (IQR, range) age of 50 (16, 35–74) years and positive histology for adrenal adenoma. Preoperatively, all patients had a single adenoma on CT and a diagnosis of PA with either DSIT or DCVT. The defined daily dose (DDD) of hypertensive drugs was assessed pre- and postoperatively. DSIT or DCVT and basal ARR were reassessed postoperatively.

Results

Two of the 41 patients failed to suppress aldosterone post-surgery, leading to a post-adrenalectomy biochemical cure rate of 95%, while blood pressure was improved in 36 patients, leading to a clinical cure rate of 88% as assessed by the DDD methodology.

Conclusions

The present study was a proof-of-concept process to validate two modified diagnostic tests for PA in clinical practice. These tests, used to diagnose a group of patients with PA, successfully assessed their biochemical cure post-adrenalectomy at rates similar to those reported in the literature.

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Data availability statement

The data are available on request

Data availability

The data are available on demand.

Code availability

Not applicable

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Author information

Authors and Affiliations

  1. 2nd Department of Surgery, Aretaieion Hospital, Medical School, National and Kapodistrian University of Athens, 76th Vasilissis Sofias Avenue, 115 28, Athens, Greece

    Krystallenia I. Alexandraki

  2. Department of Endocrinology and Diabetes Center, General Hospital of Athens “G. Gennimatas”, Athens, Greece

    Athina Markou, Labrini Papanastasiou, Ernestini Tyfoxylou, Chara Kapsali, Christos Gravvanis & George Piaditis

  3. Department of Endocrinology, Diabetes and Metabolic Diseases, Henry Dunant Hospital Center, Athens, Greece

    Pinelopi Katsiveli & George Piaditis

  4. Endocrine Unit, 1st Department of Propaedeutic Medicine, Laiko Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece

    Gregory A. Kaltsas

  5. Third Department of Surgery, General Hospital of Athens “G. Gennimatas”, Athens, Greece

    George N. Zografos

  6. University Research Institute of Maternal and Child Health & Precision Medicine, UNESCO Chair on Adolescent Health Care, National and Kapodistrian University of Athens, “Aghia Sophia” Children’s Hospital, Athens, Greece

    George P. Chrousos

Authors
  1. Krystallenia I. Alexandraki
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  2. Athina Markou
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  10. George P. Chrousos
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  11. George Piaditis
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Corresponding author

Correspondence to Krystallenia I. Alexandraki.

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Ethics approval

The study protocol was approved by the Institutional Ethics Committee of the General Hospital of Athens “G. Gennimatas”, and informed consent was obtained from all the study participants.

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The authors declare no competing interests.

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Alexandraki, K.I., Markou, A., Papanastasiou, L. et al. Surgical treatment outcome of primary aldosteronism assessed using new modified diagnostic tests. Hormones 20, 359–368 (2021). https://doi.org/10.1007/s42000-021-00280-8

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  • DOI: https://doi.org/10.1007/s42000-021-00280-8

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