Masao Takeda1, Koichi Yamamoto1, Hiroshi Akasaka1, Hiromi Rakugi1, Mitsuhide Naruse2, Yoshiyu Takeda3, Isao Kurihara4, Hiroshi Itoh4, Hironobu Umakoshi2, Mika Tsuiki2, Takamasa Ichijo5, Takuyuki Katabami6, Norio Wada7, Yui Shibayama7, Takanobu Yoshimoto8, Yoshihiro Ogawa8, Junji Kawashima9, Masakatsu Sone10, Nobuya Inagaki10, Katsutoshi Takahashi11,12, Megumi Fujita13, Minemori Watanabe14, Yuichi Matsuda15, Hiroki Kobayashi16, Hirotaka Shibata17, Kohei Kamemura18, Michio Otsuki19, Yuichi Fujii20, Atsushi Ogo21, Shintaro Okamura22, Shozo Miyauchi23, Toshihiko Yanase24, Tomoko Suzuki25, Takashi Kawamura26. 1. Department of Geriatric and General Medicine, Osaka University Graduate School of Medicine, Osaka, Japan. 2. Department of Endocrinology and Metabolism, National Hospital Organization Kyoto Medical Center, Kyoto, Japan. 3. Department of Internal Medicine, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan. 4. Department of Endocrinology, Metabolism and Nephrology, School of Medicine Keio University, Tokyo, Japan. 5. Department of Endocrinology and Metabolism, Saiseikai Yokohamashi Tobu Hospital, Yokohama, Japan. 6. Division of Metabolism and Endocrinology, Department of Internal Medicine, St. Marianna University School of Medicine Yokohama City Seibu Hospital, Yokohama, Japan. 7. Department of Diabetes and Endocrinology, Sapporo City General Hospital, Sapporo, Japan. 8. Department of Molecular Endocrinology and Metabolism, Tokyo Medical and Dental University, Tokyo, Japan. 9. Department of Metabolic Medicine, Faculty of Life Science, Kumamoto University, Kumamoto University, Kumamoto, Japan. 10. Department of Diabetes, Endocrinology and Nutrition Kyoto University, Kyoto, Japan. 11. Division of Nephrology and Endocrinology, University of Tokyo School of Medicine, Tokyo, Japan. 12. Division of Metabolism, Showa General Hospital, Tokyo, Japan. 13. Division of Nephrology and Endocrinology, University of Tokyo, Tokyo, Japan. 14. Department of Endocrinology and Diabetes, Okazaki City Hospital, Okazaki, Japan. 15. Department of Cardiology, Sanda City Hospital, Sanda, Japan. 16. Division of Nephrology, Hypertension and Endocrinology, Nihon University School of Medicine, Tokyo, Japan. 17. Department of Endocrinology, Metabolism, Rheumatology and Nephrology, Faculty of Medicine, Oita University, Yufu, Japan. 18. Department of Cardiology, Akashi Medical Center, Akashi, Japan. 19. Department of Metabolic Medicine, Osaka University Graduate School of Medicine, Osaka, Japan. 20. Department of Cardiology, JR Hiroshima Hospital, Hiroshima, Japan. 21. Clinical Research Institute, National Hospital Organization Kyusyu Medical Center, Fukuoka, Japan. 22. Department of Endocrinology, Tenriyorozu Hospital, Tenri, Nara, Japan. 23. Department of Internal Medicine, Uwajima City Hospital, Uwajima, Japan. 24. Department of Endocrinology and Diabetes Mellitus, Faculty of Medicine, Fukuoka University, Fukuoka, Japan. 25. Department of Public Health, School of Medicine, International University of Health and Welfare, Narita, Japan. 26. Kyoto University Health Service, Kyoto, Japan.
Abstract
Context: Primary aldosteronism (PA) in the elderly has increased in importance in association with population aging. Objective: To investigate the characteristics and outcomes of elderly patients with PA undergoing adrenalectomy. Patients and Methods: Using a database of patients with PA who underwent adrenal venous sampling (AVS), we compared elderly patients (≥65 years old) with nonelderly patients (<65 years old) in terms of characteristics, subtype classification in ACTH-stimulated AVS, and outcomes after adrenalectomy. Results: The elderly group had a higher prevalence of comorbidities than the nonelderly group. The proportion of the unilateral subtype [defined as a lateralization index (LI) >4] was comparable between the age groups. In patients who received adrenalectomy, biochemical cure was comparable between the groups, whereas persistent hypertension was more common in the elderly group. The prevalences of hyperkalemia and renal impairment (chronic kidney disease stage 3b or higher) were higher in the elderly group. Multiple regression analysis showed that the duration of hypertension predicted persistent hypertension and hyperkalemia and that preoperative estimated glomerular filtration rate predicted renal impairment in the elderly group. LI >4 in AVS was an independent predictor of biochemical cure after adrenalectomy in the elderly group but not in the nonelderly group. Age was negatively associated with biochemical cure in patients with LI ≤4. Conclusion: Adrenalectomy contributes to biochemical improvement in elderly patients if determined in accordance with AVS. The treatment strategy should be determined considering the high postoperative incidence of persistent hypertension and hyperkalemia in elderly patients with a long history of hypertension or renal impairment in those with reduced renal function.
Context: Primary aldosteronism (PA) in the elderly has increased in importance in association with population aging. Objective: To investigate the characteristics and outcomes of elderly patients with PA undergoing adrenalectomy. Patients and Methods: Using a database of patients with PA who underwent adrenal venous sampling (AVS), we compared elderly patients (≥65 years old) with nonelderly patients (<65 years old) in terms of characteristics, subtype classification in ACTH-stimulated AVS, and outcomes after adrenalectomy. Results: The elderly group had a higher prevalence of comorbidities than the nonelderly group. The proportion of the unilateral subtype [defined as a lateralization index (LI) >4] was comparable between the age groups. In patients who received adrenalectomy, biochemical cure was comparable between the groups, whereas persistent hypertension was more common in the elderly group. The prevalences of hyperkalemia and renal impairment (chronic kidney disease stage 3b or higher) were higher in the elderly group. Multiple regression analysis showed that the duration of hypertension predicted persistent hypertension and hyperkalemia and that preoperative estimated glomerular filtration rate predicted renal impairment in the elderly group. LI >4 in AVS was an independent predictor of biochemical cure after adrenalectomy in the elderly group but not in the nonelderly group. Age was negatively associated with biochemical cure in patients with LI ≤4. Conclusion: Adrenalectomy contributes to biochemical improvement in elderly patients if determined in accordance with AVS. The treatment strategy should be determined considering the high postoperative incidence of persistent hypertension and hyperkalemia in elderly patients with a long history of hypertension or renal impairment in those with reduced renal function.
Authors: Davis Sam; Gregory A Kline; Benny So; Janice L Pasieka; Adrian Harvey; Alex Chin; Stefan J Przybojewski; Alexander A Leung Journal: J Clin Endocrinol Metab Date: 2021-01-23 Impact factor: 5.958
Authors: Graeme Eisenhofer; Claudio Durán; Carlo Vittorio Cannistraci; Mirko Peitzsch; Tracy Ann Williams; Anna Riester; Jacopo Burrello; Fabrizio Buffolo; Aleksander Prejbisz; Felix Beuschlein; Andrzej Januszewicz; Paolo Mulatero; Jacques W M Lenders; Martin Reincke Journal: JAMA Netw Open Date: 2020-09-01