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Objective: The clinical significance of immunohistochemistry (IHC) for unilateral primary aldosteronism (PA) has been unclear. Individualized follow‐up of PA patients could be in sight. Long‐term outcomes of patients, classified based on IHC, need further investigation. We aimed to assess long‐term clinical outcomes for unilateral PA, classifying patients based on IHC. Design: A nationwide observational study, with up to 16 years follow‐up, executed in 2007–2016 at Landspitali University Hospital, tertiary referral center. Patients were diagnosed and treated in line with the current guidelines. Haematoxylin and eosin (H&E) tissue slides were stained using CYP11B1 and ‐B2 antibodies. All cases were re‐evaluated and classified according to the HISTALDO consensus. Outcomes were assessed using the PASO criteria. Patients: All unilateral PA patients diagnosed in 2007‐2016 in Iceland, 26 patients aged 28–73 years, who underwent adrenalectomy, were included. Measurements: Aldosterone, renin, and cortisol values, use and dosage of antihypertensives, potassium supplementation, blood pressure and serum potassium pre‐intervention and throughout follow‐up, and histopathology results post‐adrenalectomy. Results: Following IHC, an aldosterone‐producing nodule was seen in 12 adrenals, an aldosterone‐producing adenoma in 10 and multiple aldosterone‐producing micronodules in four. IHC altered histopathology from previous H&E diagnosis in 23% (6/26) of the patients. In total, 81% (21/26) of the patients had partial clinical success. Eight percent (2/26) of the patients needed potassium supplementation during follow‐up. In the classical group, the AVS results were more determinative with significantly higher lateralization index (median 10.1 vs. 5.3, p =.04) and more contralateral suppression (median nondominant ratio 0.4 vs. 1.0, p =.03). One out of five patients with complete clinical success at 12 months post‐op had severe relapse later, the other four were normotensive without antihypertensives for up to 10 years. Conclusions: We found IHC mandatory for accurate histopathologic diagnosis of PA. Our results support the importance of contralateral suppression when interpreting AVS results. Also, the study highlights the complicated assessment of clinical outcome and importance of aldosterone and renin measurements during follow‐up. [ABSTRACT FROM AUTHOR]

Long-term follow-up studies on primary aldosteronism (PA) are lacking. We aim to review results of diagnostic procedures and histopathology for patients diagnosed during 2012–2016 in Iceland, compare unilateral (UD) and bilateral disease (BD) and assess treatment response. Thirty-two patients aged 28–88 were diagnosed and treated according to guidelines. The majority had BD. Everyone needed potassium supplementation at case detection. We saw a reduction in systolic blood pressure (p <.001, both groups), antihypertensive agents (p =.002 UD and p =.04 BD) and potassium supplementation (p <.001, both groups). Similar treatment response was seen in both subgroups. Ratio of hypokalemia and number of cases indicates severe PA underdiagnosis in Iceland. [ABSTRACT FROM AUTHOR]

The authors aimed to investigate the clinical characteristics, accuracy of diagnostic tests, and long-term outcomes after interventions in patients diagnosed with primary aldosteronism (PA) in Iceland throughout 5 years. A retrospective chart review was performed for all patients diagnosed with PA during the years 2007-2011 at Landspitali Hospital in Iceland, a referral center for the whole country. Workup after detection included salt loading test, positional test, computed tomography, and adrenal vein sampling. Patients with unilateral disease were offered treatment with adrenalectomy. A total of 33 patients were diagnosed with PA during the study period: 17 patients with bilateral disease and 16 with unilateral disease. Results from salt loading test were positive in 90% of patients. In patients with adenoma, 36% were responsive on their positional test and computed tomography scan showed a nodule in 73%. All patients with unilateral disease had a lateralization index ≥3. After surgery, patients had lower systolic blood pressure (P<.001) and number of hypertensive medications (P<.01). [ABSTRACT FROM AUTHOR]