Comparison between adrenalectomy and medical therapy in the management of primary aldosteronism

Introduction: Primary aldosteronism (PA) is a disorder of the adrenal gland causing an autonomous overproduction of mineralocorticoids, leading to arterial hypertension. Objective: To assess outcome between adrenalectomy and the use of mineralocorticoid receptor antagonist (MRA) in primary aldos...

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Main Authors:	Loh, Huai Heng, S, Norlela, AW, Norasyikin, M, Norlaila, Zainuddin, Suehazlyn, R, Subashini, O, Mohd Rahman, Shahar, Mohammad Arif, Omar, Ahmad Marzuki, WS, Wan Juani, D, Azura, OOI, CP, Kamaruddin, Nor Azmi
Format:	Article
Language:	English
Published:	Malaysian Endocrine and Metabolic Society 2014
Subjects:	RC Internal medicine
Online Access:	http://irep.iium.edu.my/48173/ http://irep.iium.edu.my/48173/ http://irep.iium.edu.my/48173/6/PP-041.pdf

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recordtype	eprints
spelling	iium-481732018-06-12T03:15:27Z http://irep.iium.edu.my/48173/ Comparison between adrenalectomy and medical therapy in the management of primary aldosteronism Loh, Huai Heng S, Norlela AW, Norasyikin M, Norlaila Zainuddin, Suehazlyn R, Subashini O, Mohd Rahman Shahar, Mohammad Arif Omar, Ahmad Marzuki WS, Wan Juani D, Azura OOI, CP Kamaruddin, Nor Azmi RC Internal medicine Introduction: Primary aldosteronism (PA) is a disorder of the adrenal gland causing an autonomous overproduction of mineralocorticoids, leading to arterial hypertension. Objective: To assess outcome between adrenalectomy and the use of mineralocorticoid receptor antagonist (MRA) in primary aldosteronism. Materials and Methods Registry of all patients with treated PA referred to our center from 2001 till 2013 were reviewed. Demographics of the patients and outcome one year after treatment were analysed. Results: There were 12 female and 10 male patients. Mean age was 49.23 ± 11.3. Median duration of hypertension prior to diagnosis of PA was 7.5 ± 8.3 years. Median aldosterone renin ratio was 53.2 (aldosterone in ng/ dL, renin in ng/ml/h). 82% had fludrocortisone suppression as confirmatory test. 45.5% underwent adrenalectomy, 36.4% received MRA, with mean dose of 75mg/day. Mean potassium level pre-treatment was 2.75 ± 0.72mmol/L, with post level of 4.35 ± 0.43mmol/L. In the adrenalectomy arm, there was significant improvement in SBP (p=0.001) and potassium level (p<0.001) post treatment. In the MRA arm, there was significant improvement in SBP (p=0.001), DBP (p=0.001) and potassium level (p=0.002). Post adrenalectomy patients required less anti-hypertensive treatment compared to patients who received MRA (p=0.039). There was no significant difference in blood pressure improvement (p=0.43 for SBP, p=0.13 for DBP) and potassium improvement (p=0.58) between two modalities of treatment. Conclusion: Both adrenalectomy and medical therapy resulted in significant improvement in both blood pressure and potassium level. Due to the small number of subjects, only reduction of anti-hypertensive treatment heralds the superiority of surgery over medical treatment in this study. Malaysian Endocrine and Metabolic Society 2014-05 Article PeerReviewed application/pdf en http://irep.iium.edu.my/48173/6/PP-041.pdf Loh, Huai Heng and S, Norlela and AW, Norasyikin and M, Norlaila and Zainuddin, Suehazlyn and R, Subashini and O, Mohd Rahman and Shahar, Mohammad Arif and Omar, Ahmad Marzuki and WS, Wan Juani and D, Azura and OOI, CP and Kamaruddin, Nor Azmi (2014) Comparison between adrenalectomy and medical therapy in the management of primary aldosteronism. Journal of Endocrinology and Metabolism, 4 (1(Sup)). p. 28. ISSN 2229-9572 http://www.jmems.org/index.php/jmems/issue/view/5
repository_type	Digital Repository
institution_category	Local University
institution	International Islamic University Malaysia
building	IIUM Repository
collection	Online Access
language	English
topic	RC Internal medicine
spellingShingle	RC Internal medicine Loh, Huai Heng S, Norlela AW, Norasyikin M, Norlaila Zainuddin, Suehazlyn R, Subashini O, Mohd Rahman Shahar, Mohammad Arif Omar, Ahmad Marzuki WS, Wan Juani D, Azura OOI, CP Kamaruddin, Nor Azmi Comparison between adrenalectomy and medical therapy in the management of primary aldosteronism
description	Introduction: Primary aldosteronism (PA) is a disorder of the adrenal gland causing an autonomous overproduction of mineralocorticoids, leading to arterial hypertension. Objective: To assess outcome between adrenalectomy and the use of mineralocorticoid receptor antagonist (MRA) in primary aldosteronism. Materials and Methods Registry of all patients with treated PA referred to our center from 2001 till 2013 were reviewed. Demographics of the patients and outcome one year after treatment were analysed. Results: There were 12 female and 10 male patients. Mean age was 49.23 ± 11.3. Median duration of hypertension prior to diagnosis of PA was 7.5 ± 8.3 years. Median aldosterone renin ratio was 53.2 (aldosterone in ng/ dL, renin in ng/ml/h). 82% had fludrocortisone suppression as confirmatory test. 45.5% underwent adrenalectomy, 36.4% received MRA, with mean dose of 75mg/day. Mean potassium level pre-treatment was 2.75 ± 0.72mmol/L, with post level of 4.35 ± 0.43mmol/L. In the adrenalectomy arm, there was significant improvement in SBP (p=0.001) and potassium level (p<0.001) post treatment. In the MRA arm, there was significant improvement in SBP (p=0.001), DBP (p=0.001) and potassium level (p=0.002). Post adrenalectomy patients required less anti-hypertensive treatment compared to patients who received MRA (p=0.039). There was no significant difference in blood pressure improvement (p=0.43 for SBP, p=0.13 for DBP) and potassium improvement (p=0.58) between two modalities of treatment. Conclusion: Both adrenalectomy and medical therapy resulted in significant improvement in both blood pressure and potassium level. Due to the small number of subjects, only reduction of anti-hypertensive treatment heralds the superiority of surgery over medical treatment in this study.
format	Article
author	Loh, Huai Heng S, Norlela AW, Norasyikin M, Norlaila Zainuddin, Suehazlyn R, Subashini O, Mohd Rahman Shahar, Mohammad Arif Omar, Ahmad Marzuki WS, Wan Juani D, Azura OOI, CP Kamaruddin, Nor Azmi
author_facet	Loh, Huai Heng S, Norlela AW, Norasyikin M, Norlaila Zainuddin, Suehazlyn R, Subashini O, Mohd Rahman Shahar, Mohammad Arif Omar, Ahmad Marzuki WS, Wan Juani D, Azura OOI, CP Kamaruddin, Nor Azmi
author_sort	Loh, Huai Heng
title	Comparison between adrenalectomy and medical therapy in the management of primary aldosteronism
title_short	Comparison between adrenalectomy and medical therapy in the management of primary aldosteronism
title_full	Comparison between adrenalectomy and medical therapy in the management of primary aldosteronism
title_fullStr	Comparison between adrenalectomy and medical therapy in the management of primary aldosteronism
title_full_unstemmed	Comparison between adrenalectomy and medical therapy in the management of primary aldosteronism
title_sort	comparison between adrenalectomy and medical therapy in the management of primary aldosteronism
publisher	Malaysian Endocrine and Metabolic Society
publishDate	2014
url	http://irep.iium.edu.my/48173/ http://irep.iium.edu.my/48173/ http://irep.iium.edu.my/48173/6/PP-041.pdf
first_indexed	2023-09-18T21:08:23Z
last_indexed	2023-09-18T21:08:23Z
_version_	1777411087644229632

Comparison between adrenalectomy and medical therapy in the management of primary aldosteronism

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