B S Miller1, A F Turcu2, A T Nanba2, D T Hughes3, M S Cohen3, P G Gauger3, R J Auchus2. 1. Division of Endocrine Surgery, Section of General Surgery, Department of Surgery, University of Michigan, 2920 Taubman Center, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA. barbram@med.umich.edu. 2. Division of Metabolism, Endocrinology, and Diabetes, University of Michigan, Ann Arbor, MI, USA. 3. Division of Endocrine Surgery, Section of General Surgery, Department of Surgery, University of Michigan, 2920 Taubman Center, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA.
Abstract
INTRODUCTION: Determination of outcomes after adrenalectomy for primary aldosteronism (PA) is limited by the lack of standardized definitions of cure. The Primary Aldosteronism Surgical Outcomes (PASO) group recently established new consensus definitions for biochemical and clinical cure of PA. We hypothesize that utilization of PASO definitions will better stratify patient outcomes after surgery compared to original and current criteria utilized to document cure. MATERIALS AND METHODS: Patients undergoing adrenalectomy for PA from 1996 to 2016 were studied. Clinical data were reviewed. Three different sets of criteria (original, current, and PASO) were evaluated for differences in documentation of cure. Demographic data were reported as median (range). Comparisons were made using the Mann-Whitney U test; p < 0.05 is significant. RESULTS: A total of 314 patients with PA were identified. Ninety patients (60 males) elected to proceed with surgery. In Group 1 (35 patients), 30 patients had clinical follow-up and 29 (97%) were cured using original criteria. In Group 2 (55 patients), cure was recorded in 98% when original criteria for cure were applied, 89% cured applying current criteria, and 6% had complete biochemical and clinical cure by PASO criteria. Aldosterone rose 3.6 ng/dL (0.1-34.8) in five patients during extended follow-up, with two patients changing from complete to partial or missing biochemical success. CONCLUSION: Significant heterogeneity exists in outcomes criteria utilized to document cure or clinical improvement after adrenalectomy for primary aldosteronism. Aldosterone levels change over time after adrenalectomy. PASO definitions of cure appear to allow for improved stratification of short- and long-term outcomes.
INTRODUCTION: Determination of outcomes after adrenalectomy for primary aldosteronism (PA) is limited by the lack of standardized definitions of cure. The Primary Aldosteronism Surgical Outcomes (PASO) group recently established new consensus definitions for biochemical and clinical cure of PA. We hypothesize that utilization of PASO definitions will better stratify patient outcomes after surgery compared to original and current criteria utilized to document cure. MATERIALS AND METHODS:Patients undergoing adrenalectomy for PA from 1996 to 2016 were studied. Clinical data were reviewed. Three different sets of criteria (original, current, and PASO) were evaluated for differences in documentation of cure. Demographic data were reported as median (range). Comparisons were made using the Mann-Whitney U test; p < 0.05 is significant. RESULTS: A total of 314 patients with PA were identified. Ninety patients (60 males) elected to proceed with surgery. In Group 1 (35 patients), 30 patients had clinical follow-up and 29 (97%) were cured using original criteria. In Group 2 (55 patients), cure was recorded in 98% when original criteria for cure were applied, 89% cured applying current criteria, and 6% had complete biochemical and clinical cure by PASO criteria. Aldosterone rose 3.6 ng/dL (0.1-34.8) in five patients during extended follow-up, with two patients changing from complete to partial or missing biochemical success. CONCLUSION: Significant heterogeneity exists in outcomes criteria utilized to document cure or clinical improvement after adrenalectomy for primary aldosteronism. Aldosterone levels change over time after adrenalectomy. PASO definitions of cure appear to allow for improved stratification of short- and long-term outcomes.
Authors: William F Young; Anthony W Stanson; Geoffrey B Thompson; Clive S Grant; David R Farley; Jon A van Heerden Journal: Surgery Date: 2004-12 Impact factor: 3.982
Authors: Gian Paolo Rossi; Marlena Barisa; Bruno Allolio; Richard J Auchus; Laurence Amar; Debbie Cohen; Christoph Degenhart; Jaap Deinum; Evelyn Fischer; Richard Gordon; Ralph Kickuth; Gregory Kline; Andre Lacroix; Steven Magill; Diego Miotto; Mitsuhide Naruse; Tetsuo Nishikawa; Masao Omura; Eduardo Pimenta; Pierre-François Plouin; Marcus Quinkler; Martin Reincke; Ermanno Rossi; Lars Christian Rump; Fumitoshi Satoh; Leo Schultze Kool; Teresa Maria Seccia; Michael Stowasser; Akiyo Tanabe; Scott Trerotola; Oliver Vonend; Jiri Widimsky; Kwan-Dun Wu; Vin-Cent Wu; Achille Cesare Pessina Journal: J Clin Endocrinol Metab Date: 2012-03-07 Impact factor: 5.958
Authors: Vivien Lim; Qinghua Guo; Clive S Grant; Geoffrey B Thompson; Melanie L Richards; David R Farley; William F Young Journal: J Clin Endocrinol Metab Date: 2014-05-05 Impact factor: 5.958
Authors: Sabine C Käyser; Tanja Dekkers; Hans J Groenewoud; Gert Jan van der Wilt; J Carel Bakx; Mark C van der Wel; Ad R Hermus; Jacques W Lenders; Jaap Deinum Journal: J Clin Endocrinol Metab Date: 2016-05-12 Impact factor: 5.958
Authors: Matthew L White; Paul G Gauger; Gerard M Doherty; Kyung J Cho; Norman W Thompson; Gary D Hammer; Barbra S Miller Journal: Surgery Date: 2008-12 Impact factor: 3.982
Authors: Paolo Mulatero; Michael Stowasser; Keh-Chuan Loh; Carlos E Fardella; Richard D Gordon; Lorena Mosso; Celso E Gomez-Sanchez; Franco Veglio; William F Young Journal: J Clin Endocrinol Metab Date: 2004-03 Impact factor: 5.958
Authors: C A Proye; E A Mulliez; B M Carnaille; M Lecomte-Houcke; M Decoulx; J L Wémeau; J Lefebvre; A Racadot; O Ernst; D Huglo; A Carré Journal: Surgery Date: 1998-12 Impact factor: 3.982