title: Predictors of successful outcome after adrenalectomy for primary aldosteronism.
abstract: The underlying cause of resistant hypertension after adrenalectomy for primary hyperaldosteronism remains controversial. The objective of this study was to identify preoperative factors predictive of resistant hypertension in patients after undergoing retroperitoneoscopic adrenalectomy. Between 2003 and 2009, 124 patients with unilateral aldosterone-producing adenoma or unilateral adrenal hyperplasia underwent retroperitoneoscopic adrenalectomy at our institution. Clinical and biochemical data were reviewed retrospectively at baseline and after a median follow-up time of 59.2 ± 37.2 months. Adrenalectomy cured hypertension in 68 patients (54.8%) and 43 (34.8%) had persistent hypertension that was much easier to control after surgery, whereas 13 patients (10.4%) had continued hypertension and poor blood pressure control. Multivariate regression analysis revealed that the main determinants of postoperative cure were duration of hypertension less than 5 years [odds ratio (OR): 6.515, 95% confidence interval (CI) 2.278-10.293), number of antihypertensive medications ≤2 (OR: 2.939, 95% CI 1.254-5.235), preoperative response to spironolactone (OR: 3.405, 95% CI 1.681-6.985), the TT genotype of the CYP11B2 gene (344 C/T) (OR: 2.765, 95% CI 1.221-4.986), and the presence of adenoma rather than hyperplasia (OR: 5.274, 95% CI 2.150-8.141). The main determinants of surgical cure or control of hypertension in patients with primary hyperaldosteronism were duration of hypertension, number of antihypertensive medications, preoperative response to spironolactone, the presence of adenoma, and CYP11B2 (344 C/T) genotype. Consideration of these factors may help in the evaluation of patients for surgery and for the identification of patients with continued postoperative hypertension that may require more long-term monitoring and treatment.
authors.affiliation: Department of Urology, Guangzhou General Hospital of Guangzhou Military Command (Guangzhou Liuhuaqiao Hospital), Guangzhou, Guangdong province, China.
authors.forename: Wei
authors.initials: W
authors.lastname: Wang
authors.forename: WeiLie
authors.initials: W
authors.lastname: Hu
authors.forename: XiaoMing
authors.initials: X
authors.lastname: Zhang
authors.forename: BangQi
authors.initials: B
authors.lastname: Wang
authors.forename: Chen
authors.initials: C
authors.lastname: Bin
authors.forename: Hai
authors.initials: H
authors.lastname: Huang
mesh_terms: D000236:Adenoma / Q000150:complications* / Q000235:genetics / Q000601:surgery; D000310:Adrenal Gland Neoplasms / Q000150:complications* / Q000235:genetics / Q000601:surgery; D000312:Adrenal Hyperplasia, Congenital / Q000150:complications* / Q000235:genetics / Q000601:surgery; D000315:Adrenalectomy / Q000379:methods; D000328:Adult; D019405:Cytochrome P-450 CYP11B2 / Q000235:genetics; D003661:Decision Support Techniques; D005260:Female; D005500:Follow-Up Studies; D005819:Genetic Markers; D060005:Genotyping Techniques; D006801:Humans; D006929:Hyperaldosteronism / Q000209:etiology / Q000235:genetics / Q000601:surgery*; D006973:Hypertension / Q000209:etiology* / Q000235:genetics; D007008:Hypokalemia / Q000209:etiology / Q000235:genetics; D010535:Laparoscopy; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D020641:Polymorphism, Single Nucleotide; D057234:Preoperative Period; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D005819:Genetic Markers; D019405:Cytochrome P-450 CYP11B2