Surgery for Primary Aldosteronism in France from 2010 to 2020, Results from the French-Speaking Association of Endocrine Surgery (AFCE) - Eurocrine® Study Group

Abstract

Objective: Describe the diagnostic work-up and postoperative results for patients treated by adrenalectomy for primary aldosteronism in France from 2010 to 2020 Summary Background Data: Primary aldosteronism (PA) is the underlying cause of hypertension in 6-18% patients. French and international guidelines recommend CT-scan and adrenal vein sampling as part of diagnostic work-up to distinguish unilateral PA amenable to surgical treatment, from bilateral PA that will require lifelong antialdosterone treatment. Adrenalectomy for unilateral primary aldosteronism has been associated with complete resolution of hypertension (no antihypertensive drugs and normal ambulatory pressure) in about 1/3 of patients, and complete biological success in 94% of patients. These results are mainly based on retrospective studies with short follow-up and aggregated patients from various international high volume centres. Methods: Here we report results from French-Speaking Association of Endocrine Surgery (AFCE) using the Eurocrine® Database. Results: Over 11 years, 385 patients from 10 medical centres were eligible for analysis, accounting for >40% of adrenalectomies performed in France for primary aldosteronism over the period. Preoperative work-up was consistent with guidelines for 40% patients. Complete clinical success (CCS) at last follow-up was achieved in 32% patients and complete biological success was not sufficiently assessed. For patients with two follow-up visits, clinical results were not persistent at one year for 1/5 patients. Factors associated with CCS on multivariate analysis were body mass index, duration of hypertension and number of antihypertensive drugs. Conclusions: These results call for an improvement in thorough preoperative work-up and long-term follow-up of patients (clinical and biological) to early manage hypertension and/or PA relapse.