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Medical or surgical therapy for primary aldosteronism: post-treatment follow-up as a surrogate measure of comparative outcomes.
- Source :
-
Annals of surgical oncology [Ann Surg Oncol] 2013 Jul; Vol. 20 (7), pp. 2274-8. Date of Electronic Publication: 2013 Mar 16. - Publication Year :
- 2013
-
Abstract
- Background: In primary aldosteronism (PA), lateralized aldosterone excess can be treated with aldosterone antagonists or surgery, which raises the question as to whether surgery or medications should be the preferred management. A difference in required patient follow-up/clinic resource utilization might provide a surrogate estimate of the comparative outcome efficacy of medical versus surgical therapy.<br />Methods: From a retrospective review of our adrenal vein sampling (AVS) database June 2005 to August 2011, we chose all patients with PA who were surgical candidates and investigated with AVS. There were 77 subjects; 38 (with aldosteronoma) had unilateral adrenalectomy, and 39 (7 aldosteronoma and 32 hyperplasia) were treated with primary medical therapy. After AVS, patients with nonsurgical disease immediately started mineralocorticoid antagonists and follow-up measured from the AVS date. Surgical patients were seen in the clinic immediately after hospital discharge and follow-up measured from the operative date. Target BP was <140/90 before discharge to the community.<br />Results: Total follow-up ranged from 1 to 55 months, and 4 subjects were lost to follow-up. Mean follow-up in the medical and surgical groups was 13.4 versus 6.5 months (p < 0.004). There was a trend toward more clinic visits for the medical group (7.0 vs 5.2, p = 0.17).<br />Conclusions: Most PA patients can be managed by medical or surgical approaches. Medically treated patients require much longer-term follow-up to manage their condition, whereas most surgical patients can be successfully discharged shortly after surgery. When possible, surgical management may represent a more expeditious means of treating PA.
- Subjects :
- Adenoma complications
Adrenal Gland Neoplasms complications
Adrenal Glands surgery
Adrenalectomy
Adult
Aldosterone blood
Antihypertensive Agents therapeutic use
Blood Pressure
Diuretics, Potassium Sparing therapeutic use
Female
Humans
Hyperaldosteronism etiology
Hyperplasia complications
Hyperplasia therapy
Hypertension drug therapy
Hypertension etiology
Hypokalemia drug therapy
Hypokalemia etiology
Male
Middle Aged
Mineralocorticoid Receptor Antagonists therapeutic use
Office Visits statistics & numerical data
Renin blood
Retrospective Studies
Adenoma therapy
Adrenal Gland Neoplasms therapy
Adrenal Glands pathology
Health Resources statistics & numerical data
Hyperaldosteronism therapy
Subjects
Details
- Language :
- English
- ISSN :
- 1534-4681
- Volume :
- 20
- Issue :
- 7
- Database :
- MEDLINE
- Journal :
- Annals of surgical oncology
- Publication Type :
- Academic Journal
- Accession number :
- 23504117
- Full Text :
- https://doi.org/10.1245/s10434-013-2871-3