OR40-1 Primary Aldosteronism Treated with Unilateral Adrenalectomy: Long-Term Follow-up

Program: Abstracts - Orals, Featured Poster Presentations, and Posters
Session: OR40-Renin-Angiotensin-Aldosterone System/Endocrine Hypertension
Monday, June 17, 2013: 11:15 AM-12:45 PM
Presentation Start Time: 11:15 AM
Room 135 (Moscone Center)
Vivien Lim*1, Qinghua Guo2, Clive S. Grant3, Geoffrey B Thompson3, Melanie L. Richards3, David R. Farley3 and William F Young3
1Khoo Teck Puat Hospital, Singapore, Singapore, 2PLA General Hospital, Beijing, China, 3Mayo Clinic, Rochester, MN
Background: We studied the preoperative subtype localization studies, immediate postoperative plasma aldosterone concentration (PAC), and long-term follow-up in those patients with primary aldosteronism (PA) treated with unilateral adrenalectomy.

Methods: This was a retrospective observational study of all patients who underwent unilateral adrenalectomy for treatment of PA at Mayo Clinic, Rochester, between January, 1993, to December, 2011.

Results: Over 19 years, 263 patients underwent unilateral adrenalectomy for the treatment of PA. Long-term postoperative follow-up (mean, 6.8 ± 4.9 yrs) was obtained in 143 patients (54.4%). The overall effective cure rate of PA in patients that had been sent for adrenalectomy for presumptive unilateral disease was 95.5%. In the PA cured subgroup, the pathology in 108 (85.0%) patients was a single adrenal adenoma, 4 (3.1%) had more than one adenoma and 15 (11.8%) patients had unilateral zona glomerulosa hyperplasia. PA was not cured with unilateral adrenalectomy in 6 patients (4.2%). The immediate postoperative PAC was a good predictor of cure: PAC <6.4 ng/dL = cured; PAC >10 ng/dL = not cured. Computed imaging and adrenal venous sampling (AVS) were concordant to the surgically documented side in 58.6% and 97.1% of the patients, respectively. Although there was no statistically significant difference in mean age between the overall inaccurate adrenal imaging group vs. that of the accurate adrenal imaging group, we found that the minimum age in the former was 35.1 years.

Conclusions:  Using adrenal computed imaging and AVS, the effective surgical cure rate for PA was 95.5%. The immediate postoperative PAC was a good predictor of cure. Although the overall accuracy of computed adrenal imaging in detecting unilateral adrenal disease was poor at 58.6%, adrenal imaging performed well in those patients less than 35 years of age.

Nothing to Disclose: VL, QG, CSG, GBT, MLR, DRF, WFY

*Please take note of The Endocrine Society's News Embargo Policy at http://www.endo-society.org/endo2013/media.cfm

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