Prediction of long-term biochemical cure in patients with unilateral primary hyperaldosteronism treated surgically based on the early post-operative plasma aldosterone value
Prediction of long-term biochemical cure in patients with unilateral primary hyperaldosteronism treated surgically based on the early post-operative plasma aldosterone value
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DOI：
10.1507/endocrj.ej21-0430
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发表时间：
2021-11-06
影响因子：
2
通讯作者：
Tagami, Tetsuya
中科院分区：
文献类型：
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作者：
Ishihara, Yuki;Umakoshi, Hironobu;Tagami, Tetsuya
2017年，原发性醛固酮增多症手术结局（PASO）研究者提出了临床和生化结局的共识标准。然而，需要经过6至12个月，以评估接受手术治疗原发性醛固酮增多症患者的结局。本研究旨在根据术后10天内获得的实验室检查结果评估原发性醛固酮增多症（PA）的术后生化和临床结局。我们回顾性研究了59例接受肾上腺切除术的单侧PA患者，并在初始评估（术后1-10天）和最终评估（术后6-12个月）时评估了血浆醛固酮浓度（PAC）和血浆肾素活性。当比较完全生化成功组（n = 51）和部分或无生化成功组（n = 8）时，部分或无生化成功组在初始评估时的中位术后PAC显著更高（12.7 ng/dL;四分位数间距[IQR]，10.6-14.5）高于完全生化成功组（6.3 ng/dL; IQR，5.0-7.9）（p < 0.001），而在其他因素中未观察到显著差异。初始评估时用于预测生化结局的术后PAC的受试者工作特征曲线表明，8.1 ng/dL是生化成功的最佳PAC截止值（灵敏度，76.5%;特异性，100%）。在初始评估时，术后PAC较低可预测PA的生化治愈。
In 2017, the Primary Aldosteronism Surgical Outcome (PASO) investigators proposed consensus criteria for clinical and biochemical outcomes. However, 6 to 12 months need to pass in order to assess for the outcome in patients who have undergone surgery for the management of primary hyperaldosteronism. This study aims to evaluate the post-operative biochemical and clinical outcomes of primary aldosteronism (PA) on the basis of the laboratory findings obtained within 10 days after surgery. We retrospectively studied 59 consecutive patients with unilateral PA who underwent adrenalectomy and were assessed for plasma aldosterone concentration (PAC) and plasma renin activity both at the initial assessment (1-10 days after surgery) and the final assessment (6-12 months after surgery). When comparing the complete biochemical success group (n = 51) and the partial or absent biochemical success group (n = 8), the median post-operative PAC at the initial assessment was significantly greater in the partial or absent biochemical success group (12.7 ng/dL; interquartile range [IQR], 10.6-14.5) than that in the complete biochemical success group (6.3 ng/dL; IQR, 5.0-7.9) (p < 0.001), while no significant differences were observed in other factors. The receiver operating characteristic curves of post-operative PAC at the initial assessment, which was used to predict biochemical outcomes, indicated that 8.1 ng/dL is the optimal PAC cut-off for biochemical success (sensitivity, 76.5%; specificity, 100%). Low post-operative PAC at the initial assessment may predict the biochemical cure of PA.