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Horm Metab Res 2020; 52(06): 454-458
DOI: 10.1055/a-1139-1783
Review

Age, Gender, and Body Mass Index as Determinants of Surgical Outcome in Primary Aldosteronism

Mitsuhide Naruse
1   Endocrine Center, Ijinkai Takeda General Hospital, Clinical Research Institute of Endocrinology and Metabolism, NHO Kyoto Medical Center, Kyoto, Japan
,
Koichi Yamamoto
2   Department of Geriatric and General Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
,
Takuyuki Katabami
3   Division of Metabolism and Endocrinology, St. Marianna University School of Medicine Yokohama City Seibu Hospital, Yokohama, Japan
,
Ryo Nakamaru
2   Department of Geriatric and General Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
,
Masakatsu Sone
4   Department of Diabetes, Endocrinology and Nutrition, Kyoto University, Kyoto, Japan
,
Hiroki Kobayashi 
5   Division of Nephrology, Hypertension, and Endocrinology, Nihon University School of Medicine, Tokyo, Japan
,
Akiyo Tanabe
6   Department of Diabetes, Endocrinology and Metabolism, National Center for Global Health and Medicine, Tokyo, Japan
› Author Affiliations Funding: This study was supported in part by grants-in-aid for the Japan Primary Aldosteronism Study and the Japan Rare Adrenal Diseases Study from the Practical Research Project for Rare/Intractable Diseases from the Japan Agency for Medical Research and Development (AMED) (JP17ek0109122 and JP19ek0109352) and a grant from the National Center for Global Health and Medicine, Japan (27–1402).
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Abstract

Although unilateral primary aldosteronism (PA) should be curable by adrenalectomy (ADX), postsurgical outcome is affected by several clinical factors. Herein we reviewe the importance of age, gender, and BMI as determinants of surgical success based on the recent findings including a nation-wide, multicenter study in Japan (JPAS/JRAS). It is important to determine whether ADX for elderly patients with unilateral PA is as beneficial as younger patients. JPAS/JRAS showed that ADX could benefit elderly patients (>65 years) with definitive unilateral PA in curing of disease and improvement of hypertension, although potential adverse outcomes including hyperkalemia and renal insufficiency need to be considered in some elderly patients at high risk. As shown in previous studies, JPAS/JRAS also demonstrated that female gender was an independent predictor for clinical cure after ADX in patients with unilateral PA. The gender-specific predominance of somatic mutations of aldosterone-producing adenoma and sex hormones with vasculo-protective effects might account for the difference of surgical outcome between genders. Additionally, lower body mass index (BMI) has been shown to be one of the predictive factors for better clinical outcome after ADX. The relation between BMI and surgical outcome is, however, independent from aldosterone, since BMI does not correlate with PAC in PA. Early diagnosis of PA and lifestyle modification including weight control are essential to improve the surgical outcome of the unilateral PA. Thus, clinical practice guideline should include sophisticated strategy of ADX considering not only subtype diagnosis by adrenal venous sampling but also age, gender, and BMI to predict better surgical outcome.

Key words

aldosterone - adrenalectomy - gender-specific - elderly patients - obesity


Publication History

Received: 02 December 2019

Accepted: 09 March 2020

Article published online:
06 April 2020

© Georg Thieme Verlag KG
Stuttgart · New York

 

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