Ludwig Pasquier1, Medhi Kirouani2, Florian Fanget3, Claire Nomine4, Cécile Caillard1, Vincent Arnault5, Jean-Baptiste Finel6, Niki Christou7, Muriel Mathonnet7, Christophe Trésallet2, Antoine Hamy6, Loïc de Calan5, Laurent Brunaud4, Fabrice Menegaux2, Jean Christophe Lifante3, Jean Benoit Hardouin8, Delphine Drui9, Éric Mirallié1, Claire Blanchard10. 1. Clinique de Chirurgie Digestive et Endocrinienne (CCDE), Institut des Maladies de l'Appareil Digestif (IMAD), CHU Hôtel-Dieu, 1 place Alexis Ricordeau, 44093, Nantes cedex 1, France. 2. Service de chirurgie Générale, Viscérale et Endocrinienne, Hôpital Universitaire Pitié Salpêtrière, Paris, France. 3. Service de Chirurgie Endocrinienne et Générale, Centre Hospitalier Lyon Sud, Lyon, France. 4. Service de Chirurgie Digestive, Hépatobiliaire, Pancréatique, Endocrinienne et Cancérologique, CHRU de Nancy, Nancy, France. 5. Service de Chirurgie Digestive Endocrinienne et Transplantation Hépatique, CHRU de Tours, Tours, France. 6. Service de Chirurgie Viscérale et Endocrinienne, CHU d'Angers, Angers, France. 7. Service de Chirurgie Digestive, Générale et Endocrinienne, CHU Limoges, Limoges, France. 8. Biomathematiques, Biostatistiques et Informatique, Faculté de Médecine, Université de Nantes, Nantes, France. 9. Service d'Endocrinologie, CHU Nantes, Nantes, France. 10. Clinique de Chirurgie Digestive et Endocrinienne (CCDE), Institut des Maladies de l'Appareil Digestif (IMAD), CHU Hôtel-Dieu, 1 place Alexis Ricordeau, 44093, Nantes cedex 1, France. claire.blanchard@chu-nantes.fr.
Abstract
PURPOSE: Aldosteronoma Resolution Score (ARS) is a predictive score for cure of hypertension after adrenalectomy for hyperaldosteronism and has been validated in American patients. The aim of the study was to validate this score in a French population. METHOD: Data concerning patients operated from 2002 to 2015 in 7 French University Hospitals were retrospectively collected. Diagnosis of Aldosterone-producing adenoma (APA) was confirmed with clinical and biochemical hyperaldosteronism and adrenal nodule on CT scan. Adrenal venous sampling was performed when CT failed to identify laterality. ARS is based on four variables: female sex, BMI ≤25 kg/m2, duration of hypertension ≤6 years, number of antihypertensive medications ≤2. One point is attributed for the first three and 2 points for the last. Patients were considered as cured if they had no hypertension and no antihypertensive medications at least 6 months after surgery. Patients with bilateral adrenal hyperplasia were excluded. RESULTS: This multicenter study included 310 patients with APA. ARS and follow-up were obtained in 257 patients. 46.6% of patients were cured and potassium serum level was normalized in 97.7%. In multivariate analysis, odds ratio for female sex, BMI ≤25 kg/m2, duration of hypertension ≤6 years, and number of antihypertensive medications ≤2 were 1.60 (p = 0.09), 1.77 (p = 0.04), 1.28 (p = 0.4), 3.41 (p < 0.001), respectively. Cure rate were, respectively, 22.2, 41.4 and 74% for patients with a score ARS 0-1, 2-3, 4-5. The area under the curve (AUC) of ARS was 0.715. CONCLUSION: ARS is not a predictive score efficient enough in a French population maybe due to different metabolic data and genetic conditions.
PURPOSE: Aldosteronoma Resolution Score (ARS) is a predictive score for cure of hypertension after adrenalectomy for hyperaldosteronism and has been validated in American patients. The aim of the study was to validate this score in a French population. METHOD: Data concerning patients operated from 2002 to 2015 in 7 French University Hospitals were retrospectively collected. Diagnosis of Aldosterone-producing adenoma (APA) was confirmed with clinical and biochemical hyperaldosteronism and adrenal nodule on CT scan. Adrenal venous sampling was performed when CT failed to identify laterality. ARS is based on four variables: female sex, BMI ≤25 kg/m2, duration of hypertension ≤6 years, number of antihypertensive medications ≤2. One point is attributed for the first three and 2 points for the last. Patients were considered as cured if they had no hypertension and no antihypertensive medications at least 6 months after surgery. Patients with bilateral adrenal hyperplasia were excluded. RESULTS: This multicenter study included 310 patients with APA. ARS and follow-up were obtained in 257 patients. 46.6% of patients were cured and potassium serum level was normalized in 97.7%. In multivariate analysis, odds ratio for female sex, BMI ≤25 kg/m2, duration of hypertension ≤6 years, and number of antihypertensive medications ≤2 were 1.60 (p = 0.09), 1.77 (p = 0.04), 1.28 (p = 0.4), 3.41 (p < 0.001), respectively. Cure rate were, respectively, 22.2, 41.4 and 74% for patients with a score ARS 0-1, 2-3, 4-5. The area under the curve (AUC) of ARS was 0.715. CONCLUSION:ARS is not a predictive score efficient enough in a French population maybe due to different metabolic data and genetic conditions.
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