TOPLINE:

In patients with primary aldosteronism awaiting adrenalectomy, preoperative mineralocorticoid receptor antagonist (MRA) therapy did not increase the risk for postoperative hyperkalemia, renal function decline, or hypotension. Moreover, the treatment was associated with improved biochemical outcomes in the long term.

METHODOLOGY:

• The 2016 Endocrine Society guideline recommends using MRAs to optimize blood pressure and correct hypokalemia before adrenalectomy; however, the perioperative use of these medications in patients with unilateral primary aldosteronism is not standardized.
• Researchers performed a retrospective analysis of data from a Spain-based patient registry to compare postoperative complications and outcomes after adrenalectomy in patients with primary aldosteronism who received preoperative MRA therapy with those in patients who did not.
• They analyzed data of 355 patients (mean age at diagnosis, 52 years, 45.6% women); 273 of them received spironolactone or eplerenone before adrenalectomy, and 82 did not.
• Clinical and biochemical measures were compared at diagnosis and after surgery at three follow‑up timepoints: immediate (≤ 30 days), short‑term (≤ 90 days), and long‑term (≥ 6 months); during the immediate and short‑term follow-ups, blood pressure and plasma aldosterone levels and the occurrences of hyperkalemia (potassium levels > 5.0 mmol/L) and hypoaldosteronism were recorded.
• Clinical and biochemical responses at long-term follow-up were categorized according to the Primary Aldosteronism Surgical Outcomes criteria; biochemical cure was defined as the achievement of normokalemia without potassium replacement therapy and a normalized aldosterone-to-renin ratio.

TAKEAWAY:

• Before adrenalectomy, patients who did vs did not receive MRA had a longer history of hypertension (median, 9 vs 6 years; P = .041), higher lifetime incidence of hypokalemia (80.2% vs 65.9%; P = .007), and higher levels of plasma aldosterone.
• No significant differences were observed between pretreated and nonpretreated groups in the incidence rate of postoperative hyperkalemia, hypoaldosteronism, hypotension, or renal function decline at immediate or short-term follow-up.
• At long-term follow-up, patients who were vs were not pretreated with MRAs were more likely to attain complete biochemical success (81.7% vs 57.1%; P = .004) and had a lower prevalence of left ventricular hypertrophy.
• Preoperative MRA use was independently associated with increased odds of successful postoperative biochemical cure.

IN PRACTICE:

“Our findings support the safety of preoperative MRA administration in people who are scheduled to undergo unilateral adrenalectomy for PA [primary aldosteronism]. These results may aid clinicians in optimizing the perioperative management” of this patient population, the authors concluded.

SOURCE:

The study was led by Jessica Goi, Hospital Universitario Ramón y Cajal and Instituto de Investigación Biomédica Ramón y Cajal, both in Madrid, Spain. It was published online in The Journal of Clinical Endocrinology & Metabolism.

LIMITATIONS:

The retrospective design may have affected data quality, and treatment approaches likely differed between participating centers. Assays and laboratory reference ranges were not standardized across sites, and preoperative measurements of renin levels may have been influenced by concurrent medications. Moreover, data on compliance with MRA therapy were unavailable.

DISCLOSURES:

The study received funding from the Sociedad Española de Endocrinología y Nutrición. The authors reported having no relevant conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.