title: Adrenalectomy improves increased carotid intima-media thickness and arterial stiffness in patients with aldosterone producing adenoma.
abstract: BACKGROUND
  Primary aldosteronism (PA) is the most frequent cause of secondary hypertension, and is associated with more prominent vascular stiffness and atherosclerosis. However, the effect of adrenalectomy on reversibility of vascular damage is unclear.
  
  
  OBJECTIVE
  Our objective was to investigate the vascular changes and possibility of reversibility after adrenalectomy in PA patients.
  
  
  METHODS
  We prospectively analyzed 20 patients with aldosterone producing adenoma (APA) that received adrenalectomy from October 2006 to December 2008 and 21 patients with essential hypertension (EH) were enrolled as the control group. Carotid intima media thickness (CIMT) measurement by B-mode ultrasound of the right common carotid arteries and pulse wave velocity (PWV) measurement including brachial-ankle PWV (baPWV) and heart-ankle PWV (haPWV) were performed in both groups. The follow-up measurements were performed one-year after adrenalectomy in APA group.
  
  
  RESULTS
  APA patients had significantly higher diastolic blood pressure, plasma aldosterone concentration (PAC) and aldosterone-renin ratio (ARR), but lower serum potassium level and plasma renin activity (PRA) than EH patients. APA patients had significantly higher CIMT (0.64±0.13 vs. 0.53±0.10 mm, p=0.006), higher baPWV (1589±296 vs. 1405±187 cm/s, p=0.024) and haPWV (1095±150 vs. 987±114 cm/s, p=0.013) comparing with EH patients. One-year after adrenalectomy, CIMT reduced significantly from 0.64±0.13 mm to 0.59±0.14 mm (p=0.014), and baPWV and haPWV also showed significant reduction (baPWV, 1589±296 to 1463±188 cm/s, p=0.035; haPWV, 1095±150 to 1017±109 cm/s, p=0.019).
  
  
  CONCLUSIONS
  APA patients have higher degree of early atherosclerosis and vascular stiffness. Adrenalectomy not only corrects the high blood pressure and biochemical parameters but also reverse adverse vascular change in APA patients.
authors.affiliation: Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
authors.forename: Yen-Hung
authors.initials: YH
authors.lastname: Lin
authors.forename: Lian-Yu
authors.initials: LY
authors.lastname: Lin
authors.forename: Aaron
authors.initials: A
authors.lastname: Chen
authors.forename: Xue-Ming
authors.initials: XM
authors.lastname: Wu
authors.forename: Jen-Kuang
authors.initials: JK
authors.lastname: Lee
authors.forename: Ta-Chen
authors.initials: TC
authors.lastname: Su
authors.forename: Vin-Cent
authors.initials: VC
authors.lastname: Wu
authors.forename: Shih-Chieh
authors.initials: SC
authors.lastname: Chueh
authors.forename: Wei-Chou
authors.initials: WC
authors.lastname: Lin
authors.forename: Men-Tzung
authors.initials: MT
authors.lastname: Lo
authors.forename: Pa-Chun
authors.initials: PC
authors.lastname: Wang
authors.forename: Yi-Lwun
authors.initials: YL
authors.lastname: Ho
authors.forename: Kwan-Dun
authors.initials: KD
authors.lastname: Wu
mesh_terms: D000310:Adrenal Gland Neoplasms / Q000097:blood / Q000150:complications / Q000378:metabolism / Q000601:surgery*; D000315:Adrenalectomy; D018246:Adrenocortical Adenoma / Q000097:blood / Q000150:complications / Q000378:metabolism / Q000601:surgery*; D000328:Adult; D000450:Aldosterone / Q000097:blood / Q000378:metabolism*; D000704:Analysis of Variance; D055109:Ankle Brachial Index; D001158:Arteries / Q000473:pathology / Q000503:physiopathology*; D015415:Biomarkers / Q000097:blood; D001794:Blood Pressure; D002340:Carotid Artery Diseases / Q000097:blood / Q000000981:diagnostic imaging / Q000209:etiology*; D059168:Carotid Intima-Media Thickness; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D004548:Elasticity; D005260:Female; D006439:Hemodynamics; D006801:Humans; D006929:Hyperaldosteronism / Q000097:blood / Q000209:etiology*; D006973:Hypertension / Q000097:blood / Q000209:etiology* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011188:Potassium / Q000097:blood; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011673:Pulsatile Flow; D012083:Renin / Q000097:blood; D013624:Taiwan; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D000450:Aldosterone; D012083:Renin; D011188:Potassium