Chieh-Kai Chan1, Jung-Hee Kim2, Eric Chueh3, Chin-Chen Chang4, Yu-Feng Lin5, Tai-Shuan Lai5, Kuo-How Huang6, Yen-Hung Lin7, Vin-Cent Wu8. 1. Department of Internal Medicine, National Taiwan University Hospital, Hsin-Chu Branch, Hsin Chu County, Taiwan; Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan. 2. Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea. 3. Case Western Reserve University, Cleveland, OH, USA. 4. Department of Medical Imaging, National Taiwan University Hospital, Taipei, Taiwan. 5. Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan. 6. Department of Urology, National Taiwan University Hospital, Taipei, Taiwan. 7. Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; TAIPAI, Taiwan Primary Aldosteronism Investigation (TAIPAI) Study Group, Taiwan of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan. 8. Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; TAIPAI, Taiwan Primary Aldosteronism Investigation (TAIPAI) Study Group, Taiwan of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan. Electronic address: q91421028@ntu.edu.tw.
Abstract
BACKGROUND: The saline infusion test is widely used as a confirmatory test for primary aldosteronism, and we hypothesized that post-saline-infusion test aldosterone levels might predict the clinical outcomes in primary aldosteronism patients after adrenalectomy. METHODS: An observational cohort study was performed. We included primary aldosteronism patients who had undergone adrenalectomy from the Taiwan Primary Aldosteronism Investigation database between 1995 and 2017. The patients were divided into the following 2 groups: the clinical success group and the resist hypertension group, according to the criteria from the Primary Aldosteronism Surgery Outcome consensus. RESULTS: We enrolled 236 patients with primary aldosteronism (male, 41.1%; mean age, 49.8 years). A total of 79.7% patients achieved clinical success after adrenalectomy after 12-month follow-up. The clinical success group had higher mean blood pressure, higher aldosterone-to-renin ratio, lower potassium, and lower renin levels than that of the resist hypertension group. In multivariate logistic regression analysis, post saline-infusion test aldosterone levels higher than 48 ng/dL (odds ratio, 2.51; 95% confidence interval, 1.04-6.06; P = .040), body mass index less than 25 kg/m2 (odds ratio, 2.22; 95% confidence interval, 1.12-4.40; P = .023) and mean blood pressure higher than 115 mmHg (odds ratio, 2.79; 95% confidence interval, 1.37-5.68; P = .005) could predict better clinical success rates after adrenalectomy in primary aldosteronism patients. CONCLUSION: Our study demonstrated that the post-saline-infusion test aldosterone level could not only confirm primary aldosteronism but also forecast clinical outcomes in primary aldosteronism patients after adrenalectomy.
BACKGROUND: The saline infusion test is widely used as a confirmatory test for primary aldosteronism, and we hypothesized that post-saline-infusion test aldosterone levels might predict the clinical outcomes in primary aldosteronism patients after adrenalectomy. METHODS: An observational cohort study was performed. We included primary aldosteronism patients who had undergone adrenalectomy from the Taiwan Primary Aldosteronism Investigation database between 1995 and 2017. The patients were divided into the following 2 groups: the clinical success group and the resist hypertension group, according to the criteria from the Primary Aldosteronism Surgery Outcome consensus. RESULTS: We enrolled 236 patients with primary aldosteronism (male, 41.1%; mean age, 49.8 years). A total of 79.7% patients achieved clinical success after adrenalectomy after 12-month follow-up. The clinical success group had higher mean blood pressure, higher aldosterone-to-renin ratio, lower potassium, and lower renin levels than that of the resist hypertension group. In multivariate logistic regression analysis, post saline-infusion test aldosterone levels higher than 48 ng/dL (odds ratio, 2.51; 95% confidence interval, 1.04-6.06; P = .040), body mass index less than 25 kg/m2 (odds ratio, 2.22; 95% confidence interval, 1.12-4.40; P = .023) and mean blood pressure higher than 115 mmHg (odds ratio, 2.79; 95% confidence interval, 1.37-5.68; P = .005) could predict better clinical success rates after adrenalectomy in primary aldosteronism patients. CONCLUSION: Our study demonstrated that the post-saline-infusion test aldosterone level could not only confirm primary aldosteronism but also forecast clinical outcomes in primary aldosteronism patients after adrenalectomy.