Dataset Information

Therapeutic outcomes with surgical and medical management for primary aldosteronism: protocol for a systematic review and meta-analysis.

ABSTRACT:

Introduction

Treatment strategies for primary aldosteronism (PA) include unilateral adrenalectomy and medical treatment with mineralocorticoid receptor (MR) antagonists. Whether these two different treatment strategies are comparable in mitigating the detrimental effect of PA on outcomes is still debated.

Objectives

The primary aim of this systematic review is to identify, appraise and synthesise existing literature comparing clinical outcomes after treatment in patients with PA.

Methods and analysis

A systematic and comprehensive search will be performed using PubMed, Web of Science and EMBASE, for studies published until December 2022. Observational and interventional studies will be eligible for inclusion. The quality of observational studies will be assessed using the Newcastle-Ottawa Scale, while interventional studies will be assessed using the Cochrane Effective Practice Organization of Care tool. The collected evidence will be narratively synthesised. We will perform meta-analysis to pool estimates from studies considered to be homogeneous. Reporting of the systematic review and meta-analysis will be in accordance with the Meta-analysis of Observational Studies in Epidemiology Preferred Reporting Items for Systematic reviews and Meta-Analysis guidelines.

Ethics and dissemination

As this study is based solely on the published literature, no ethics approval is required. This review will aim to provide some estimates on outcomes, including survival, rates of clinical and biochemical control, cardiovascular and cerebrovascular events, as well as data on quality of life and renal function, in patients with PA treated surgically or with MR antagonists. The study findings will be presented at scientific meetings and will be published in an international peer-reviewed scientific journal.

Prospero registration number

CRD42022362506.

SUBMITTER: Rocca A

PROVIDER: S-EPMC10387625 | biostudies-literature | 2023 Jul

REPOSITORIES: biostudies-literature

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Publications

Therapeutic outcomes with surgical and medical management for primary aldosteronism: protocol for a systematic review and meta-analysis.

Rocca Aldo A Gkaniatsa Eleftheria E Brunese Maria Chiara MC Hessman Eva E Muth Andreas A Nwaru Bright I BI Ragnarsson Oskar O Bobbio Emanuele E Esposito Daniela D

BMJ open 20230730 7

<h4>Introduction</h4>Treatment strategies for primary aldosteronism (PA) include unilateral adrenalectomy and medical treatment with mineralocorticoid receptor (MR) antagonists. Whether these two different treatment strategies are comparable in mitigating the detrimental effect of PA on outcomes is still debated.<h4>Objectives</h4>The primary aim of this systematic review is to identify, appraise and synthesise existing literature comparing clinical outcomes after treatment in patients with PA.< ...[more]

PMID: 37518075

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Project description:PurposeThis study aimed to explore the significance of 68Ga-pentixafor PET/CT in guiding surgical treatments for primary aldosteronism (PA) patients, by identifying functional lesions and determining the dominant side of aldosterone secretion.Materials and methodsWe prospectively included 91 PA patients receiving surgical treatments based on the results of 68Ga-pentixafor PET/CT. The 68Ga-pentixafor PET/CT images were evaluated by visual and semi-quantitative analysis. The relationship between radionuclide imaging characteristics and postoperative outcomes was assessed following surgery.ResultsThe positive detection rate of 68Ga-pentixafor PET/CT in 91 PA patients was 85.7 % (78/91) with a median maximum standardized uptake value (SUVmax) of 10.2 (6.0-16.0). The SUVmax was positively correlated with lesion diameter (r = 0.497, P < 0.001), while negatively correlated with the blood potassium level (r = -0.450, P < 0.001) and plasma renin activity (r = -0.297, P = 0.004). 63 cases of 73 PA patients with unilateral adrenal lesion were identified positive by 68Ga-pentixafor PET/CT, and 95.2 % of the 63 positive cases benefited from surgical resection of the identified positive lesions. Among 18 PA patients with bilateral lesions, 68Ga-pentixafor PET/CT identified positive lesions in 15 cases, and 86.7 % (13/15) of the positive cases benefited from total or partial adrenalectomy guided by 68Ga-pentixafor PET/CT. There was no significant difference in postoperative outcomes between patients undergoing partial adrenalectomy with those subjected to total adrenalectomy. The accuracy rate of 68Ga-pentixafor PET/CT in determining the dominant side of aldosterone secretion for PA was 85.7 %, which was comparable to the 71.4 % of adrenal vein sampling (AVS).Conclusions68Ga-pentixafor PET/CT could effectively guide the surgical management for PA patients, achieving favorable postoperative outcomes. The accuracy rate of 68Ga-pentixafor PET/CT in identifying the dominant side of aldosterone secretion was not inferior to that of AVS.

Project description:ImportanceIn addition to biochemical cure, clinical benefits after surgery for primary aldosteronism depend on the magnitude of decrease in blood pressure (BP) and use of antihypertensive medications with a subsequent decreased risk of cardiovascular and/or cerebrovascular morbidity and drug-induced adverse effects.ObjectiveTo evaluate the change in BP and use of antihypertensive medications within an international cohort of patients who recently underwent surgery for primary aldosteronism.Design, setting, and participantsA cohort study was conducted across 16 referral medical centers in Europe, the United States, Canada, and Australia. Patients who underwent unilateral adrenalectomy for primary aldosteronism between January 2010 and December 2016 were included. Data analysis was performed from August 2017 to June 2018. Unilateral disease was confirmed using computed tomography, magnetic resonance imaging, and/or adrenal venous sampling. Patients with missing or incomplete preoperative or follow-up data regarding BP or corresponding number of antihypertensive medications were excluded.Main outcomes and measuresClinical success was defined based on postoperative BP and number of antihypertensive medications. Cure was defined as normotension without antihypertensive medications, and clear improvement as normotension with lower or equal use of antihypertensive medications. In patients with preoperative normotensivity, improvement was defined as postoperative normotension with lower antihypertensive use. All other patients were stratified as no clear success because the benefits of surgery were less obvious, mainly owing to postoperative, persistent hypertension. Clinical outcomes were assessed at follow-up closest to 6 months after surgery.ResultsOn the basis of inclusion and exclusion criteria, a total of 435 patients (84.6%) from a cohort of 514 patients who underwent unilateral adrenalectomy were eligible. Of these patients, 186 (42.3%) were women; mean (SD) age at the time of surgery was 50.7 (11.4) years. Cure was achieved in 118 patients (27.1%), clear improvement in 135 (31.0%), and no clear success in 182 (41.8%). In the subgroup classified as no clear success, 166 patients (91.2%) had postoperative hypertension. However, within this subgroup, the mean (SD) systolic and diastolic BP decreased significantly by 9 (22) mm Hg (P < .001) and 3 (15) mm Hg (P = .04), respectively. Also, the number of antihypertensive medications used decreased from 3 (range, 0-7) to 2 (range, 0-6) (P < .001). Moreover, in 75 of 182 patients (41.2%) within this subgroup, the decrease in systolic BP was 10 mm Hg or greater.Conclusions and relevanceIn this study, for most patients, adrenalectomy was associated with a postoperative normotensive state and reduction of antihypertensive medications. Furthermore, a significant proportion of patients with postoperative, persistent hypertension may benefit from adrenalectomy given the observed clinically relevant and significant reduction of BP and antihypertensive medications.

Dataset Information

Therapeutic outcomes with surgical and medical management for primary aldosteronism: protocol for a systematic review and meta-analysis.

Introduction

Objectives

Methods and analysis

Ethics and dissemination

Prospero registration number

Publications

Therapeutic outcomes with surgical and medical management for primary aldosteronism: protocol for a systematic review and meta-analysis.

Similar Datasets

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