scholarly journals Outcomes After Surgery for Unilateral Dominant Primary Aldosteronism in Sweden

2019 ◽  
Vol 44 (2) ◽  
pp. 561-569 ◽  
Author(s):  
Fredrik Sellgren ◽  
Anna Koman ◽  
Erik Nordenström ◽  
Per Hellman ◽  
Joakim Hennings ◽  
...  
Keyword(s):  
Primary Aldosteronism ◽  
Clinical Success ◽  
Mandatory Reporting ◽  
Invasive Approach ◽  
Potassium Supplementation ◽  
Quality Register ◽  
Defined Daily Doses ◽  
Biochemical Cure ◽  
Cure Rates

Abstract Background Primary aldosteronism (PA) is the most common cause of secondary hypertension. Surgery is the mainstay of treatment for unilateral dominant PA, but reported cure rates varies. The aim of the present study was to investigate contemporary follow-up practices and cure rates after surgery for PA in Sweden. Methods Patients operated for PA and registered in the Scandinavian Quality Register for Thyroid, Parathyroid and Adrenal Surgery (SQRTPA) 2009–2015 were identified. Patient data were extracted, and follow-up data (1–24 months) was recorded. Doses of antihypertensive medication and potassium supplementation were calculated using defined daily doses (DDD), and the Primary Aldosteronism Surgical Outcome (PASO) criteria were used to evaluate outcomes. Results Of 190 registered patients, 171 (47% female, mean age 53 years, median follow-up 3.7 months) were available for analysis. In 75 patients (44%), missing data precluded evaluation of biochemical cure according to the PASO criteria. Minimal invasive approach was used in 168/171 patients (98%). Complication rate (Clavien-Dindo >3a) was 3%. No mortality was registered. Pre/postoperatively 98/66% used antihypertensives (mean DDD 3.7/1.5). 89/2% had potassium supplementation (mean DDD 2.0/0) before/after surgery. Complete/partial biochemical and clinical success according to the PASO criteria were achieved in 92/7% and 34/60%, respectively. Conclusion In this study, reflecting contemporary clinical practice in Sweden complete/partial biochemical and clinical success after surgery for PA was 92/7% and 34/60%. Evaluation of biochemical cure was hampered by lack of uniform reporting of relevant outcome measures. We suggest mandatory reporting of surgical outcomes using the PASO criteria for all units performing surgery for PA.

scholarly journals Re-Evaluating Absent Clinical Success After Adrenalectomy in Unilateral Primary Aldosteronism

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A298-A298
Author(s):  
Troy Puar ◽  
Yvonne Chan ◽  
Lih-Ming Loh ◽  
Roger Foo ◽  
Peng Chin Kek
Keyword(s):  
Diabetes Mellitus ◽  
Primary Aldosteronism ◽  
Clinical Success ◽  
Significant Proportion ◽  
Antihypertensive Medications ◽  
Unilateral Adrenalectomy ◽  
Recommended Treatment ◽  
Post Surgery ◽  
Biochemical Cure

Abstract Introduction: Adrenalectomy cures unilateral primary aldosteronism (PA), and improves or cures hypertension. However, a significant proportion of patients are classified with absent clinical success post-surgery, suggesting that surgery was ineffective. Methods: We assessed all patients 6–12 months after unilateral adrenalectomy for clinical outcomes using Primary Aldosteronism Surgical Outcomes (PASO), AVIS-2 and CONNsortium criteria. We estimated blood pressure (BP) changes after adjustment for changes in defined daily dosages (DDD) of antihypertensive medications. Finally, patients were reassessed using PASO at their most recent clinical visit. Results: 104 patients with unilateral PA underwent adrenalectomy at two tertiary centres from 2000–2019. 24 (23%), 31(30%) and 54 (52%) patients were classified with absent clinical success using PASO, AVIS-2 and CONNsortium criteria respectively. Amongst 24 patients with absent clinical success using PASO criteria, 10 had complete biochemical cure, 3 partial, 2 absent, and 9 had resolution of hypokalemia. On multivariate analysis, absent clinical success was associated with presence of hyperlipidemia, diabetes mellitus and lower DDD at baseline. After adjustment for changes in DDD, 7 of 24 patients showed BP improvement ≥20/10mmHg. After follow-up of mean 5.6 years, 12 of 24 patients showed partial or complete clinical success when reassessed using PASO criteria. Only 6 of 104 (5.8%) patients failed to show any clinical improvement after surgery. Conclusions: Although some patients may be classified with absent clinical success post-surgery, majority demonstrate evidence of clinical benefit. Unilateral adrenalectomy remains the recommended treatment option for patients with unilateral PA.

Arterial Stiffness Is Associated with Clinical Outcome and Cardiorenal Injury in Lateralized Primary Aldosteronism

2020 ◽  
Vol 105 (11) ◽  
Author(s):  
Chieh-Kai Chan ◽  
Wei-Shiung Yang ◽  
Yen-Hung Lin ◽  
Kuo-How Huang ◽  
Ching-Chu Lu ◽  
...  
Keyword(s):  
Arterial Stiffness ◽  
Clinical Outcome ◽  
Left Ventricular Mass ◽  
Primary Aldosteronism ◽  
Clinical Success ◽  
Multivariate Logistic Regression Analysis ◽  
Left Ventricular ◽  
Secondary Outcome ◽  
Ventricular Mass

Abstract Context The association between arterial stiffness and clinical outcome in lateralized primary aldosteronism (PA) patients after adrenalectomy has not been clearly identified. Objective We hypothesized that arterial stiffness estimated by brachial-ankle pulse wave velocity (baPWV) before adrenalectomy was associated with the clinical outcomes and cardiorenal injury in lateralized PA patients after adrenalectomy. Design and Patients We designed a retrospective observational cohort study. We collected lateralized PA patients who had undergone adrenalectomy between 2013 and 2016 from the Taiwan Primary Aldosteronism Investigation database. The primary outcome was achieving complete clinical success at 1 year after adrenalectomy. The secondary outcome was estimated glomerular filtration rate declining over 20% and improved left ventricular mass index. Results We enrolled 221 patients with lateralized PA (50.7% men; mean age, 51.9 years), of whom 101 patients (45.7%) achieved complete clinical success at the 1-year follow-up assessment after adrenalectomy. Lower baPWV before adrenalectomy (odds ratio = 0.998; 95% confidence interval, 0.996-0.999; P = 0.003) correlated with higher likelihood of complete clinical success by multivariate logistic regression analysis. Multifactorial adjusted generalized additive model demonstrated that preoperative baPWV<1600 cm/sec was significantly associated with complete cure of hypertension. In addition, higher preoperative baPWV was associated with renal function decline and less left ventricular mass regression after adrenalectomy in lateralized PA patients during the follow-up period. Conclusions Our study demonstrated that the preoperative severe arterial stiffness was associated with absent complete clinical success in lateralized PA patients after adrenalectomy, and this effect may contribute to cardiorenal injury, which at least partially explains kidney function deterioration and lessened regression of heart mass.

scholarly journals Does Contralateral Suppression at Adrenal Venous Sampling Predict Outcome Following Unilateral Adrenalectomy for Primary Aldosteronism? A Retrospective Study

2015 ◽  
Vol 100 (4) ◽  
pp. 1477-1484 ◽  
Author(s):  
Martin J. Wolley ◽  
Richard D. Gordon ◽  
Ashraf H. Ahmed ◽  
Michael Stowasser
Keyword(s):  
Retrospective Study ◽  
Primary Aldosteronism ◽  
Median Number ◽  
Antihypertensive Medications ◽  
Unaffected Side ◽  
Unilateral Adrenalectomy ◽  
Contralateral Suppression ◽  
Biochemical Cure ◽  
Lateralization Index

Context: In primary aldosteronism (PA), adrenal vein sampling (AVS) distinguishes unilateral and bilateral disease by comparison of aldosterone/cortisol (A/F) ratios. There is controversy about the criteria for interpretation, however, and in particular it is not clear whether contralateral suppression (CS) (defined as A/Fadrenal ≤ A/Fperipheral on the unaffected side) is important. We therefore performed a retrospective study to determine whether CS in surgically treated unilateral PA was associated with blood pressure (BP) and biochemical outcomes. Setting and Design: Patients who underwent unilateral adrenalectomy for PA after successful AVS were included if the lateralization index (A/Fdominant:A/Fnondominant) was ≥2. Cases were reviewed at 6 to 24 months follow-up for outcomes with respect to the presence and degree of CS. Results: Sixty-six of 80 patients had CS. Baseline characteristics were similar. At postoperative follow-up, those with CS had lower systolic BP (SBP) (128 mm Hg vs 144 mm Hg, P = .001), a greater proportion with cure or improvement of hypertension (96% vs 64%, P = .0034), a greater proportion with biochemical cure of PA on fludrocortisone suppression testing (43 of 49 [88%] vs 4 of 9 [44%], P = .002) and were taking a lower median number of antihypertensive medications (0 vs 1.5, P = .0032). In a multivariate model, the degree of CS and preoperative SBP were both significantly correlated with postoperative SBP, but the lateralization index, sex, and age were not. Conclusion: In this study, the presence of CS correlated with good BP and biochemical outcomes from surgery. This finding suggests that CS should be a factor in deciding whether to offer surgery for treatment of PA.

scholarly journals The Coronal Tooth Fractures: Preliminary Evaluation of a Three-Year Follow-Up of the Anterior Teeth Direct Fragment Reattachment Technique Without Additional Preparation

2017 ◽  
Vol 11 (1) ◽  
pp. 266-275 ◽  
Author(s):  
Lo Giudice G ◽  
Alibrandi A. ◽  
Lipari F ◽  
Lizio A ◽  
Lauritano F ◽  
...  
Keyword(s):  
Clinical Success ◽  
Adhesive System ◽  
Resin Cement ◽  
Long Term Results ◽  
Preliminary Evaluation ◽  
Invasive Approach ◽  
Anterior Teeth ◽  
Tooth Preparation

Objective: The aim of this research is to describe and to analyse the long-term results and the clinical steps of direct fragment reattachment technique with no additional tooth preparation, used to treat crown fracture. This technique achieves the clinical success, combining satisfactory aesthetic and functional results with a minimally invasive approach. Methods: The 3 years follow-up included 9 patients (5 males, 4 females) with coronal fracture. In all the cases the fragment was available and intact. The authors illustrate the adhesive procedure used. Under local anaesthesia and after positioning the rubber dam, both the tooth and the fragment surface were etched, rinsed and applied by the adhesive system in order to obtain the retention of the fractured part to the tooth without additional tooth preparation or resin cement. Results: The statistical analysis shows the good performances of direct fragment reattachment technique. After 36 months, in 22.2% of the cases, the detachment was observed of the bonded fragment and in 11.1% of patients, complications were recorded. Conclusion: Our clinical experience shows how the ultra-conservative procedure used is fast, easy and offers a long term predictability; it also allows good functional and aesthetic outcomes.

scholarly journals Predictors of Clinical Success After Surgery for Primary Aldosteronism in the Japanese Nationwide Cohort

2019 ◽  
Vol 3 (11) ◽  
pp. 2012-2022 ◽  
Author(s):  
Mitsuha Morisaki ◽  
Isao Kurihara ◽  
Hiroshi Itoh ◽  
Mitsuhide Naruse ◽  
Yoshiyu Takeda ◽  
...  
Keyword(s):  
Primary Aldosteronism ◽  
Prediction Models ◽  
Outcome Measure ◽  
Clinical Success ◽  
Characteristic Curve ◽  
Receiver Operator Characteristic Curve ◽  
University Hospitals ◽  
Factors Associated ◽  
History Of

Abstract Context Aldosterone-producing adenomas are a curable subtype of primary aldosteronism (PA); however, hypertension persists in some patients after adrenalectomy. Objective To identify factors associated with, and develop prediction models for, blood pressure (BP) normalization or improvement after adrenalectomy. Design Retrospective analysis of patients treated between 2006 and 2018, with a 6-month follow-up. Setting A nationwide, 29-center Japanese registry encompassing 15 university hospitals and 14 city hospitals. Patients We categorized 574 participants in the Japan Primary Aldosteronism Study, who were diagnosed with PA and underwent adrenalectomy, as BP normalized or improved, on the basis of their presentations at 6 months postsurgery. Main Outcome Measure The rate of complete, partial, and absent clinical success. Predictive factors related to BP outcomes after PA surgery were also evaluated. Results Complete clinical success was achieved in 32.6% and partial clinical success was achieved in 53.0% of the patients at 6 months postsurgery. The following five variables were independent predictors for BP normalization: ≤7 years of hypertension, body mass index ≤25 kg/m2, no more than one antihypertensive medication, absence of medical history of diabetes, and female sex. The area under the receiver operator characteristic curve was 0.797 in the BP normalization model. Conclusion We established models that predicted postoperative BP normalization in patients with PA. These should be useful for shared decision-making regarding adrenalectomy for PA.

scholarly journals Treatment of Unilateral PA by Adrenalectomy: Potential Reasons for Incomplete Biochemical Cure

2018 ◽  
Vol 127 (02/03) ◽  
pp. 100-108 ◽  
Author(s):  
Yuhong Yang ◽  
Martin Reincke ◽  
Tracy Williams
Keyword(s):  
Primary Aldosteronism ◽  
Clinical Success ◽  
Target Organ Damage ◽  
Organ Damage ◽  
Unilateral Adrenalectomy ◽  
Cerebrovascular Events ◽  
Medication Dosage ◽  
Aldosterone Production ◽  
Clinical Benefits ◽  
Biochemical Cure

AbstractThe importance of an early diagnosis and appropriate management of patients with primary aldosteronism (PA) has become increasingly clear because of the adverse impact of the disorder on cardiovascular and cerebrovascular events and target organ damage. Adrenalectomy potentially cures patients with unilateral PA resulting in normalisation of blood pressure or significant clinical improvements in the majority of patients. Different criteria have been used to evaluate outcomes of unilateral adrenalectomy. Clinical remission (cure of hypertension) is observed in 6% to 86% of patients and clinical benefits from surgery are seen in the majority. Several factors have been identified that predict clinical success after surgery such as age, sex, anti-hypertensive medication dosage and known duration of hypertension. Biochemical remission of PA after unilateral adrenalectomy, characterised by the resolution of hyperaldosteronism and correction of pre-surgical hypokalaemia, is observed in 67% to 100% of patients with unilateral PA. In only a small proportion of patients, adrenalectomy fails to resolve hyperaldosteronism and inappropriate aldosterone production persists after surgery. In this review we discuss the potential reasons for failing to cure hyperaldosteronism after unilateral adrenalectomy for unilateral primary aldosteronism.

scholarly journals Impact of immunohistochemistry on the diagnosis and management of primary aldosteronism: An important tool for improved patient follow-up

2019 ◽  
Vol 109 (2) ◽  
pp. 133-142 ◽  
Author(s):  
C. Volpe ◽  
B. Hamberger ◽  
J. Zedenius ◽  
C. C. Juhlin
Keyword(s):  
Primary Aldosteronism ◽  
Significant Risk ◽  
Final Diagnosis ◽  
Secondary Hypertension ◽  
Histopathological Diagnosis ◽  
Unilateral Adrenalectomy ◽  
Aldosterone Producing Adenoma ◽  
Histopathological Workup ◽  
Cure Rates

Background and Aims: Primary aldosteronism is a common cause of secondary hypertension. Primary aldosteronism is caused by an aldosterone-producing adenoma or bilateral hyperplasia that in some cases is asymmetrical with one adrenal dominating aldosterone secretion. Most patients with aldosterone-producing adenoma are biochemically cured by unilateral adrenalectomy, but patients with bilateral hyperplasia have a significant risk of residual or recurrent disease. Here, immunohistochemistry of CYP11B1 and B2 was used to investigate whether these markers could aid in the diagnostic workup of primary aldosteronism patients. Materials and Methods: A total of 39 patients with primary aldosteronism who underwent unilateral adrenalectomy for a presumed adenoma during 2013–2016 were included. Immunohistochemistry using monoclonal antibodies identifying the enzymes CYP11B1 and B2 was part of routine histopathological workup in 6 cases; in 33 cases, it was applied retrospectively. The hyperplasia diagnosis was suggested when there was no dominating nodule but immunoreactivity for CYP11B2 was seen in several nodules, which were also seen on routine sections. To distinguish between adenoma and hyperplasia, a ratio between the largest and second largest CYP11B2-positive nodules was calculated. Results: In all, 22 patients had an aldosterone-producing adenoma, while 13 patients were judged to have hyperplasia. In four cases, a final diagnosis could not be established, thus these were judged equivocal. Among the 33 cases investigated retrospectively, the primary histopathological diagnosis was altered from hyperplasia to aldosterone-producing adenoma in 9 cases (27%) after immunohistochemistry, and the immunohistochemically rectified adenoma group displayed improved clinical cure rates compared to the routine H&E-diagnosed cohort. Moreover, the B2 ratio was significantly higher in adenoma than in hyperplasia and equivocal cases. Conclusion: Immunohistochemistry detecting CYP11B1 and B2 expression is of great help in establishing a final histopathological diagnosis in patients with primary aldosteronism. This procedure should be part of the histopathological routine in all operated primary aldosteronism patients.

scholarly journals 11C-metomidate PET CT versus Adrenal Vein Sampling for diagnosing surgically curable primary aldosteronism: prospective test validation, and impact of somatic genotype and ethnicity on outcomes

2021 ◽  
Author(s):  
Xilin Wu ◽  
Russell Senanayake ◽  
Emily Goodchild ◽  
Waiel Bashari ◽  
Jackie Salsbury ◽  
...  
Keyword(s):  
Primary Aldosteronism ◽  
Odds Ratio ◽  
Clinical Success ◽  
Ct Scanning ◽  
Primary Objective ◽  
Adrenal Vein ◽  
Adrenal Vein Sampling ◽  
Non Invasive ◽  
Pet Ct ◽  
Biochemical Cure

Abstract Primary aldosteronism (PA) due to a unilateral aldosterone-producing adenoma (APA) is a common, curable cause of hypertension, but invasive methods of diagnosis and treatment contribute to <1% of patients being offered the chance of cure. The primary objective of our prospective within-patient study in 143 patients with PA was to compare accuracy of 11C-metomidate (MTO) PET-CT scanning with adrenal vein sampling (AVS) in predicting biochemical cure from PA and resolution of hypertension. Secondary outcomes addressed heterogeneity of underlying pathogenesis and prediction of patients most likely to achieve complete cure of hypertension. 128 patients reached 6-9 month follow-up. 77/78 surgical patients achieved one or more of the four hierarchically analysed Primary Aldosteronism Surgical Outcome (PASO) criteria for biochemical and clinical success. MTO was not superior to AVS but all four differences in accuracy favored MTO, with 95% CIs >-17%, the pre-specified margin of non-inferiority. The best univariate predictors of complete clinical cure were home systolic blood pressure (SBP) <135 mmHg after one month of spironolactone 100 mg daily (odds ratio 13.0 (3.72, 45.24) p<0.001) and KCNJ5 genotype of the APA (odds ratio 10.37 (2.50, 42.99) p=0.001). The latter remained significant in logistic regression on age, gender, ethnicity, and was itself predicted by elevated urine 18-hydroxycortisol:cortisol ratio. Our findings validate 11C-metomidate PET-CT for accurate, non-invasive detection of patients with unilateral PA, and identify patients most likely to benefit from adrenalectomy.

Clinical Success Using the Audio-Visual Feedback Training for Cluttering

2019 ◽  
Vol 4 (6) ◽  
pp. 1589-1594
Author(s):  
Yvonne van Zaalen ◽  
Isabella Reichel
Keyword(s):  
Visual Feedback ◽  
Clinical Success ◽  
Pause Duration ◽  
Digital Audio ◽  
Male Adolescents ◽  
Feedback Training ◽  
Positive Effects ◽  
Speech Monitoring ◽  
Adolescents And Adults

Purpose Among the best strategies to address inadequate speech monitoring skills and other parameters of communication in people with cluttering (PWC) is the relatively new but very promising auditory–visual feedback (AVF) training ( van Zaalen & Reichel, 2015 ). This study examines the effects of AVF training on articulatory accuracy, pause duration, frequency, and type of disfluencies of PWC, as well as on the emotional and cognitive aspects that may be present in clients with this communication disorder ( Reichel, 2010 ; van Zaalen & Reichel, 2015 ). Methods In this study, 12 male adolescents and adults—6 with phonological and 6 with syntactic cluttering—were provided with weekly AVF training for 12 weeks, with a 3-month follow-up. Data was gathered on baseline (T0), Week 6 (T1), Week 12 (T2), and after follow-up (T3). Spontaneous speech was recorded and analyzed by using digital audio-recording and speech analysis software known as Praat ( Boersma & Weenink, 2017 ). Results The results of this study indicated that PWC demonstrated significant improvements in articulatory rate measurements and in pause duration following the AVF training. In addition, the PWC in the study reported positive effects on their ability to retell a story and to speak in more complete sentences. PWC felt better about formulating their ideas and were more satisfied with their interactions with people around them. Conclusions The AVF training was found to be an effective approach for improving monitoring skills of PWC with both quantitative and qualitative benefits in the behavioral, cognitive, emotional, and social domains of communication.

Transarterial embolization of peripheral arteriovenous malformations with ethylenevinyl alcohol copolymer - feasibility, technical outcomes, and clinical outcomes

VASA ◽  
2016 ◽  
Vol 45 (6) ◽  
pp. 497-504 ◽  
Author(s):  
Tom De Beule ◽  
Jan Vranckx ◽  
Peter Verhamme ◽  
Veerle Labarque ◽  
Marie-Anne Morren ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Clinical Improvement ◽  
Arteriovenous Malformations ◽  
Clinical Success ◽  
Transarterial Embolization ◽  
Recurrent Bleeding ◽  
Complete Disappearance ◽  
Ethylene Vinyl Alcohol ◽  
Initial Symptoms

Abstract. Background: The technical and clinical outcomes of catheter-directed embolization for peripheral arteriovenous malformations (AVM) using Onyx® (ethylene-vinyl alcohol copolymer) are not well documented. The purpose of this study was to retrospectively assess the safety, technical outcomes and clinical outcomes of catheter-directed Onyx® embolisation for the treatment of symptomatic peripheral AVMs. Patients and methods: Demographics, (pre-)interventional clinical and radiological data were assessed. Follow-up was based on hospital medical records and telephone calls to the patients’ general practitioners. Radiological success was defined as complete angiographic eradication of the peripheral AVM nidus. Clinical success was defined as major clinical improvement or complete disappearance of the initial symptoms. Results: 25 procedures were performed in 22 patients. The principal indications for treatment were pain (n = 10), limb swelling (n = 6), recurrent bleeding (n = 2), tinnitus (n = 3), and exertional dyspnoea (n = 1). Complete radiological success was obtained in eight patients (36 %); near-complete eradication of the nidus was achieved in the remaining 14 patients. Adjunctive embolic agents were used in nine patients (41 %). Clinical success was observed in 18 patients (82%). Major complications were reported in two patients (9 %). During follow-up, seven patients (32 %) presented with symptom recurrence, which required additional therapy in three patients. Conclusions: Catheter-directed embolisation of peripheral AVMs with Onyx® resulted in major clinical improvement or complete disappearance of symptoms in the vast majority of patients, although complete angiographic exclusion of the AVMs occurred in only a minority of patients.

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