Abstract:

Objective: Primary hyperaldosteronism (PA) is a disorder in which non-suppressible hypersecretion of aldosterone from the adrenal gland. Treatment with either mineralocorticoid receptor antagonists (MRA) or unilateral adrenalectomy (ADX) of PA resolves hypokalemia, lowers blood pressure and ameliorates the parameters of impaired cardiac and renal function but may paradoxically result in a decline in estimated glomerular filtration rate (eGFR). This study compared the effects of ADX and MRA on clinical and biochemical outcomes in patients with PA. Methods: Sixty-two patients with PA were recruited for this study. The patients were divided into two groups according to the PA treatment method. Group 1 (n=40) was defined as patients treated with MRA, and group 2 (n=22) was defined as patients who underwent ADX. Groups were compared in terms of creatinine, eGFR, potassium, sodium, plasma aldosterone concentration (PAC), plasma renin activity (PRA), aldosterone/renin ratio (ARR), presence of hypertension, and the percentage change in creatinine, eGFR, potassium, sodium. The correlation analysis between the percentage change in eGFR and the percent change of potassium with clinical and laboratory parameters was also performed. Results: The mean age of the whole study group was 54.0±9.9 years. All patients had hypertension at baseline, and 11 patients (50%) had complete clinical success with hypertension without antihypertensive drugs after the treatment with ADX. Forthy-one patient had hypokalemia at baseline, and all of them resolved after the treatment with MRA or ADX. PAC, ARR, patients with hypokalemia, the percent change in eGFR and potassium were significantly higher in group 2 than in group 1 (p<0.001, p=0.006, p=0.011, p=0.031, and p<0.001; respectively). Significant positive correlations were observed between the percent change in eGFR and the percent change of potassium with PAC and ARR in the whole study group. Conclusion: ADX could provide more benefit to renal function and resolve hypertension than the treatment of MRA. Aldosterone-induced glomerular hyperfiltration in PA resolves after both treatments and results in a more prominent decline in eGFR. Therefore, physicians should reevaluate the renal function after the treatments because pretreatment eGFR alone may not be a good predictor of renal function.

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