Mineralocorticoid Receptor Antagonist Pre-Adrenalectomy in Primary Aldosteronism

Abstract Context Perioperative use of mineralocorticoid receptor antagonists (MRA) in patients with unilateral primary aldosteronism (PA) awaiting surgery is not well standardized. Objective The aim of this study was to compare the risk of postoperative complications and surgical outcomes between PA...

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Detalles Bibliográficos
Autores: Goi, Jessica, Paja Fano, Miguel, Rizo Gellida, Alicia, González-Boillos, Marga, Martín Rojas-Marcos, Patricia, Caja Guayerbas, Laura, García Cano, Ana María, Ruiz-Sanchez, Jorge Gabriel, Vicente, Almudena, Gómez-Hoyos, Emilia, Recasens, Mònica, Barahona San Millan, Rebeca, Picón César, María José, Díaz Guardiola, Patricia, Perdomo, Carolina María, Manjón-Miguélez, Laura, Rebollo Román, Ángel, Robles Lázaro, Cristina, Recio-Cordova, José María, Calatayud, María, Jiménez López, Noemi, Sampedro Nuñez, Miguel, Mena Ribas, Elena, Sanmartín Sánchez, Alicia, Gonzalvo Diaz, Cesar, Lamas, Cristina, Serrano, Joaquín, Michalopoulou, Theodora, Tenes Rodrigo, Susana, Pascual-Corrales, Eider, Jaén Aguila, Fernando, Muñoz Rivas, Nuria, Moya Mateo, Eva María, Gutiérrez-Medina, Sonsoles, Hanzu, Felicia Alexandra, Parra Ramírez, Paola, Araujo-Castro, Marta
Tipo de recurso: artículo
Fecha de publicación:2025
País:España
Institución:Conselleria de Salut i Consum del Govern de les Illes Balears
Repositorio:Docusalut
Idioma:inglés
OAI Identifier:oai:docusalut.com:20.500.13003/26342
Acceso en línea:https://hdl.handle.net/20.500.13003/26342
Access Level:acceso abierto
Palabra clave:Adrenalectomy
Mineralocorticoid Receptor Antagonists
Adrenalectomía
Antagonistas de Receptores de Mineralocorticoides
mineralocorticoid receptor antagonist
adrenalectomy
primary aldosteronism
spironolactone
Descripción
Sumario:Abstract Context Perioperative use of mineralocorticoid receptor antagonists (MRA) in patients with unilateral primary aldosteronism (PA) awaiting surgery is not well standardized. Objective The aim of this study was to compare the risk of postoperative complications and surgical outcomes between PA patients treated with MRA prior to adrenalectomy and those not pretreated. Methods Adrenalectomized patients for unilateral PA from the SPAIN-ALDO registry, with clinical, hormonal, and treatment information before and after adrenalectomy, were analyzed. Results A total of 355 surgically treated patients were included; 76.9% (n = 273) received presurgical treatment with MRA (spironolactone [64.5%], eplerenone [35.5%]). Adrenalectomy was guided by lateralization at adrenal venous sampling in 33.5% of the overall cohort, and by imaging in all the other cases. Patients pretreated with MRA had longer duration of hypertension, higher prevalence of hypokalemia, and greater aldosterone concentrations than those not pretreated (n = 82). No differences in the rate of postsurgical hyperkalemia, hypoaldosteronism, renal function impairment, blood pressure changes, and biochemical outcomes were detected between groups in the immediate (≤30 days) and short-term (≤90 days) follow-up evaluations after surgery. At long-term follow-up (≥6 months), patients pretreated with MRA exhibited better postsurgical biochemical outcomes (81.7% had complete biochemical response vs 57.1% of non-pretreated patients; P = .004). In the multivariable analysis, the use of MRA prior to adrenalectomy was independently associated with a successful postsurgical biochemical response. Conclusion Preoperative MRA therapy can be safely introduced to control blood pressure and potassium levels in patients with PA awaiting surgery, without increasing the risk of postoperative hyperkalemia, hypoaldosteronism, renal impairment, or hypotension.

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