Outcome of adrenalectomy for unilateral primary aldosteronism: International consensus and remission rates
Identifieur interne : 000669 ( Main/Exploration ); précédent : 000668; suivant : 000670Outcome of adrenalectomy for unilateral primary aldosteronism: International consensus and remission rates
Auteurs : Tracy A. Williams [Allemagne, Italie] ; Jacques Wm Lenders [Pays-Bas, Allemagne] ; Paolo Mulatero [Italie] ; Jacopo Burrello [Italie] ; Marietta Rottenkolber [Allemagne] ; Christian Adolf [Allemagne] ; Fumitoshi Satoh [Japon] ; Laurence Amar [France] ; Marcus Quinkler [Allemagne] ; Jaap Deinum [Pays-Bas] ; Felix Beuschlein [Allemagne] ; Kanako K. Kitamoto [Japon] ; Uyen Pham [Australie] ; Ryo Morimoto [Japon] ; Hironobu Umakoshi [Japon] ; Aleksander Prejbisz [Pologne] ; Tomaz Kocjan [Slovénie] ; Mitsuhide Naruse [Japon] ; Michael Stowasser [Australie] ; Tetsuo Nishikawa [Japon] ; William F. Young [États-Unis] ; Celso E. Gomez-Sanchez [États-Unis] ; John W. Funder [Australie] ; Martin Reincke [Allemagne]Source :
- The lancet. Diabetes & endocrinology [ 2213-8587 ] ; 2017.
Abstract
Although unilateral primary aldosteronism is the most common surgically correctable cause of hypertension there are no standard criteria to classify surgical outcomes.
The Primary Aldosteronism Surgical Outcome study reached consensus by an international panel of 31 experts, including 6 endocrine surgeons, using the Delphi method. On the basis of standardised criteria, remission (complete, partial, absent) rates for clinical and biochemical outcomes were determined in retrospective cohorts (n=30-99) of consecutive patients unilaterally adrenalectomized based on adrenal venous sampling from 12 tertiary centres in 9 countries over 4 continents.
Consensus was reached for 6 criteria of clinical and biochemical outcome and 2 recommendations for follow-up. Complete clinical success was achieved in 37% of patients, with a wide variance (17-62%), and partial clinical success in an additional 47% (35-66%); complete biochemical success was seen in 94% (83-100%). Female patients had a higher likelihood of complete clinical success (OR=2.25; 95% CI, 1.40-3.62) and clinical benefit (complete + partial clinical success) (OR=2.89; 95% CI, 1.49-5.59). Younger patients had a higher likelihood of complete clinical success (OR=0.95 per extra year; 95% CI, 0.93-0.98) and clinical benefit (OR=0.95 per extra year; 95% CI, 0.92-0.98). Higher levels of pre-operative medication were associated with lower levels of complete clinical success.
Standardised outcome criteria are relevant for evaluating the quality of surgical treatment in individual patients and will allow the comparison of outcome data in clinical and scientific studies. The baseline clinical characteristics of a cohort contribute to the wide variation in clinical outcome rates. A majority of patients derive clinical benefit from adrenalectomy with younger patients and female patients likely to particularly benefit from a favourable surgical outcome. Screening for primary aldosteronism should nonetheless be performed in every individual fulfilling the Guideline criteria, since biochemical cure is by itself clinically important and older women and men may also derive post-operative clinical benefit.
Url:
DOI: 10.1016/S2213-8587(17)30135-3
PubMed: 28576687
PubMed Central: 5572673
Affiliations:
- Allemagne, Australie, France, Italie, Japon, Pays-Bas, Pologne, Slovénie, États-Unis
- Bavière, Berlin, District de Dresde, District de Haute-Bavière, Gueldre, Minnesota, Piémont, Saxe (Land), État du Mississippi, Île-de-France
- Berlin, Dresde, Munich, Nimègue, Paris, Turin
- Université Louis-et-Maximilien de Munich, Université Paris-Descartes, Université technique de Dresde
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Kitamoto</name><affiliation wicri:level="1"><nlm:aff id="A9">Endocrinology and Diabetes Centre, Yokohama Rosai Hospital, Yokohama 222-0036, Japan</nlm:aff><country xml:lang="fr">Japon</country><wicri:regionArea>Endocrinology and Diabetes Centre, Yokohama Rosai Hospital, Yokohama 222-0036</wicri:regionArea><wicri:noRegion>Yokohama 222-0036</wicri:noRegion></affiliation></author><author><name sortKey="Pham, Uyen" sort="Pham, Uyen" uniqKey="Pham U" first="Uyen" last="Pham">Uyen Pham</name><affiliation wicri:level="1"><nlm:aff id="A10">Endocrine Hypertension Research Centre, University of Queensland School of Medicine, Greenslopes and Princess Alexandra Hospitals, Brisbane, QLD, Australia</nlm:aff><country xml:lang="fr">Australie</country><wicri:regionArea>Endocrine Hypertension Research Centre, University of Queensland School of Medicine, Greenslopes and Princess Alexandra Hospitals, Brisbane, QLD</wicri:regionArea><wicri:noRegion>QLD</wicri:noRegion></affiliation></author><author><name sortKey="Morimoto, Ryo" sort="Morimoto, Ryo" uniqKey="Morimoto R" first="Ryo" last="Morimoto">Ryo Morimoto</name><affiliation wicri:level="1"><nlm:aff id="A6">Division of Clinical Hypertension, Endocrinology and Metabolism, Tohoku University Graduate School of Medicine, Sendai, Japan</nlm:aff><country xml:lang="fr">Japon</country><wicri:regionArea>Division of Clinical Hypertension, Endocrinology and Metabolism, Tohoku University Graduate School of Medicine, Sendai</wicri:regionArea><wicri:noRegion>Sendai</wicri:noRegion></affiliation></author><author><name sortKey="Umakoshi, Hironobu" sort="Umakoshi, Hironobu" uniqKey="Umakoshi H" first="Hironobu" last="Umakoshi">Hironobu Umakoshi</name><affiliation wicri:level="1"><nlm:aff id="A11">Department of Endocrinology, Metabolism and Hypertension, Clinical Research Institute, National Hospital Organization Kyoto Medical Centre, Kyoto, Japan</nlm:aff><country xml:lang="fr">Japon</country><wicri:regionArea>Department of Endocrinology, Metabolism and Hypertension, Clinical Research Institute, National Hospital Organization Kyoto Medical Centre, Kyoto</wicri:regionArea><wicri:noRegion>Kyoto</wicri:noRegion></affiliation></author><author><name sortKey="Prejbisz, Aleksander" sort="Prejbisz, Aleksander" uniqKey="Prejbisz A" first="Aleksander" last="Prejbisz">Aleksander Prejbisz</name><affiliation wicri:level="1"><nlm:aff id="A12">Department of Cardiology, Medical University of Wrocław, Wrocław, Poland</nlm:aff><country xml:lang="fr">Pologne</country><wicri:regionArea>Department of Cardiology, Medical University of Wrocław, Wrocław</wicri:regionArea><wicri:noRegion>Wrocław</wicri:noRegion></affiliation></author><author><name sortKey="Kocjan, Tomaz" sort="Kocjan, Tomaz" uniqKey="Kocjan T" first="Tomaz" last="Kocjan">Tomaz Kocjan</name><affiliation wicri:level="1"><nlm:aff id="A13">Department of Endocrinology, Diabetes and Metabolic Diseases, University Medical Centre Ljubljana, Ljubljana, Slovenia</nlm:aff><country xml:lang="fr">Slovénie</country><wicri:regionArea>Department of Endocrinology, Diabetes and Metabolic Diseases, University Medical Centre Ljubljana, Ljubljana</wicri:regionArea><wicri:noRegion>Ljubljana</wicri:noRegion></affiliation></author><author><name sortKey="Naruse, Mitsuhide" sort="Naruse, Mitsuhide" uniqKey="Naruse M" first="Mitsuhide" last="Naruse">Mitsuhide Naruse</name><affiliation wicri:level="1"><nlm:aff id="A11">Department of Endocrinology, Metabolism and Hypertension, Clinical Research Institute, National Hospital Organization Kyoto Medical Centre, Kyoto, Japan</nlm:aff><country xml:lang="fr">Japon</country><wicri:regionArea>Department of Endocrinology, Metabolism and Hypertension, Clinical Research Institute, National Hospital Organization Kyoto Medical Centre, Kyoto</wicri:regionArea><wicri:noRegion>Kyoto</wicri:noRegion></affiliation></author><author><name sortKey="Stowasser, Michael" sort="Stowasser, Michael" uniqKey="Stowasser M" first="Michael" last="Stowasser">Michael Stowasser</name><affiliation wicri:level="1"><nlm:aff id="A10">Endocrine Hypertension Research Centre, University of Queensland School of Medicine, Greenslopes and Princess Alexandra Hospitals, Brisbane, QLD, Australia</nlm:aff><country xml:lang="fr">Australie</country><wicri:regionArea>Endocrine Hypertension Research Centre, University of Queensland School of Medicine, Greenslopes and Princess Alexandra Hospitals, Brisbane, QLD</wicri:regionArea><wicri:noRegion>QLD</wicri:noRegion></affiliation></author><author><name sortKey="Nishikawa, Tetsuo" sort="Nishikawa, Tetsuo" uniqKey="Nishikawa T" first="Tetsuo" last="Nishikawa">Tetsuo Nishikawa</name><affiliation wicri:level="1"><nlm:aff id="A9">Endocrinology and Diabetes Centre, Yokohama Rosai Hospital, Yokohama 222-0036, Japan</nlm:aff><country xml:lang="fr">Japon</country><wicri:regionArea>Endocrinology and Diabetes Centre, Yokohama Rosai Hospital, Yokohama 222-0036</wicri:regionArea><wicri:noRegion>Yokohama 222-0036</wicri:noRegion></affiliation></author><author><name sortKey="Young, William F" sort="Young, William F" uniqKey="Young W" first="William F" last="Young">William F. Young</name><affiliation wicri:level="2"><nlm:aff id="A14">Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Internal Medicine, Mayo Clinic, Rochester, MN 55902, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Internal Medicine, Mayo Clinic, Rochester, MN 55902</wicri:regionArea><placeName><region type="state">Minnesota</region></placeName></affiliation></author><author><name sortKey="Gomez Sanchez, Celso E" sort="Gomez Sanchez, Celso E" uniqKey="Gomez Sanchez C" first="Celso E." last="Gomez-Sanchez">Celso E. Gomez-Sanchez</name><affiliation wicri:level="2"><nlm:aff id="A15">Division of Endocrinology, Department of Medicine, The University of Mississippi Medical Centre, Jackson, MS, USA; Research and Medicine Services, G.V. 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Williams</name><affiliation wicri:level="4"><nlm:aff id="A1">Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Ludwig-Maximilians-Universität München, Munich, Germany</nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Ludwig-Maximilians-Universität München, Munich</wicri:regionArea><placeName><region type="land" nuts="1">Bavière</region><region type="district" nuts="2">District de Haute-Bavière</region><settlement type="city">Munich</settlement><settlement type="city">Munich</settlement></placeName><orgName type="university">Université Louis-et-Maximilien de Munich</orgName></affiliation><affiliation wicri:level="3"><nlm:aff id="A2">Division of Internal Medicine and Hypertension, Department of Medical Sciences, University of Turin, Turin, Italy</nlm:aff><country xml:lang="fr">Italie</country><wicri:regionArea>Division of Internal Medicine and Hypertension, Department of Medical Sciences, University of Turin, Turin</wicri:regionArea><placeName><settlement type="city">Turin</settlement><region type="région" nuts="2">Piémont</region></placeName></affiliation></author><author><name sortKey="Lenders, Jacques Wm" sort="Lenders, Jacques Wm" uniqKey="Lenders J" first="Jacques Wm" last="Lenders">Jacques Wm Lenders</name><affiliation wicri:level="3"><nlm:aff id="A3">Department of Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands</nlm:aff><country xml:lang="fr">Pays-Bas</country><wicri:regionArea>Department of Medicine, Radboud University Medical Centre, Nijmegen</wicri:regionArea><placeName><settlement type="city">Nimègue</settlement><region type="province" nuts="2">Gueldre</region></placeName></affiliation><affiliation wicri:level="4"><nlm:aff id="A4">Department of Internal Medicine III, University Hospital Carl Gustav Carus, Technische Universität Dresden, Germany</nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>Department of Internal Medicine III, University Hospital Carl Gustav Carus, Technische Universität Dresden</wicri:regionArea><placeName><settlement type="city">Dresde</settlement><region type="land" nuts="1">Saxe (Land)</region><region type="district" nuts="2">District de Dresde</region></placeName><orgName type="university">Université technique de Dresde</orgName></affiliation></author><author><name sortKey="Mulatero, Paolo" sort="Mulatero, Paolo" uniqKey="Mulatero P" first="Paolo" last="Mulatero">Paolo Mulatero</name><affiliation wicri:level="3"><nlm:aff id="A2">Division of Internal Medicine and Hypertension, Department of Medical Sciences, University of Turin, Turin, Italy</nlm:aff><country xml:lang="fr">Italie</country><wicri:regionArea>Division of Internal Medicine and Hypertension, Department of Medical Sciences, University of Turin, Turin</wicri:regionArea><placeName><settlement type="city">Turin</settlement><region type="région" nuts="2">Piémont</region></placeName></affiliation></author><author><name sortKey="Burrello, Jacopo" sort="Burrello, Jacopo" uniqKey="Burrello J" first="Jacopo" last="Burrello">Jacopo Burrello</name><affiliation wicri:level="3"><nlm:aff id="A2">Division of Internal Medicine and Hypertension, Department of Medical Sciences, University of Turin, Turin, Italy</nlm:aff><country xml:lang="fr">Italie</country><wicri:regionArea>Division of Internal Medicine and Hypertension, Department of Medical Sciences, University of Turin, Turin</wicri:regionArea><placeName><settlement type="city">Turin</settlement><region type="région" nuts="2">Piémont</region></placeName></affiliation></author><author><name sortKey="Rottenkolber, Marietta" sort="Rottenkolber, Marietta" uniqKey="Rottenkolber M" first="Marietta" last="Rottenkolber">Marietta Rottenkolber</name><affiliation wicri:level="4"><nlm:aff id="A5">Diabetes Research Group, Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Ludwig-Maximilians-Universität München, Munich, Germany</nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>Diabetes Research Group, Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Ludwig-Maximilians-Universität München, Munich</wicri:regionArea><placeName><region type="land" nuts="1">Bavière</region><region type="district" nuts="2">District de Haute-Bavière</region><settlement type="city">Munich</settlement><settlement type="city">Munich</settlement></placeName><orgName type="university">Université Louis-et-Maximilien de Munich</orgName></affiliation></author><author><name sortKey="Adolf, Christian" sort="Adolf, Christian" uniqKey="Adolf C" first="Christian" last="Adolf">Christian Adolf</name><affiliation wicri:level="4"><nlm:aff id="A1">Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Ludwig-Maximilians-Universität München, Munich, Germany</nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Ludwig-Maximilians-Universität München, Munich</wicri:regionArea><placeName><region type="land" nuts="1">Bavière</region><region type="district" nuts="2">District de Haute-Bavière</region><settlement type="city">Munich</settlement><settlement type="city">Munich</settlement></placeName><orgName type="university">Université Louis-et-Maximilien de Munich</orgName></affiliation></author><author><name sortKey="Satoh, Fumitoshi" sort="Satoh, Fumitoshi" uniqKey="Satoh F" first="Fumitoshi" last="Satoh">Fumitoshi Satoh</name><affiliation wicri:level="1"><nlm:aff id="A6">Division of Clinical Hypertension, Endocrinology and Metabolism, Tohoku University Graduate School of Medicine, Sendai, Japan</nlm:aff><country xml:lang="fr">Japon</country><wicri:regionArea>Division of Clinical Hypertension, Endocrinology and Metabolism, Tohoku University Graduate School of Medicine, Sendai</wicri:regionArea><wicri:noRegion>Sendai</wicri:noRegion></affiliation></author><author><name sortKey="Amar, Laurence" sort="Amar, Laurence" uniqKey="Amar L" first="Laurence" last="Amar">Laurence Amar</name><affiliation wicri:level="4"><nlm:aff id="A7">Université Paris Descartes, Hypertension Unit, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges-Pompidou, 75015 Paris, France</nlm:aff><country xml:lang="fr">France</country><wicri:regionArea>Université Paris Descartes, Hypertension Unit, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges-Pompidou, 75015 Paris</wicri:regionArea><wicri:noRegion>75015 Paris</wicri:noRegion><placeName><settlement type="city">Paris</settlement><region type="région" nuts="2">Île-de-France</region><settlement type="city">Paris</settlement></placeName><orgName type="university">Université Paris-Descartes</orgName></affiliation></author><author><name sortKey="Quinkler, Marcus" sort="Quinkler, Marcus" uniqKey="Quinkler M" first="Marcus" last="Quinkler">Marcus Quinkler</name><affiliation wicri:level="3"><nlm:aff id="A8">Endocrinology in Charlottenburg, Berlin, Germany</nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>Endocrinology in Charlottenburg, Berlin</wicri:regionArea><placeName><region type="land" nuts="3">Berlin</region><settlement type="city">Berlin</settlement></placeName></affiliation></author><author><name sortKey="Deinum, Jaap" sort="Deinum, Jaap" uniqKey="Deinum J" first="Jaap" last="Deinum">Jaap Deinum</name><affiliation wicri:level="3"><nlm:aff id="A3">Department of Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands</nlm:aff><country xml:lang="fr">Pays-Bas</country><wicri:regionArea>Department of Medicine, Radboud University Medical Centre, Nijmegen</wicri:regionArea><placeName><settlement type="city">Nimègue</settlement><region type="province" nuts="2">Gueldre</region></placeName></affiliation></author><author><name sortKey="Beuschlein, Felix" sort="Beuschlein, Felix" uniqKey="Beuschlein F" first="Felix" last="Beuschlein">Felix Beuschlein</name><affiliation wicri:level="4"><nlm:aff id="A1">Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Ludwig-Maximilians-Universität München, Munich, Germany</nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Ludwig-Maximilians-Universität München, Munich</wicri:regionArea><placeName><region type="land" nuts="1">Bavière</region><region type="district" nuts="2">District de Haute-Bavière</region><settlement type="city">Munich</settlement><settlement type="city">Munich</settlement></placeName><orgName type="university">Université Louis-et-Maximilien de Munich</orgName></affiliation></author><author><name sortKey="Kitamoto, Kanako K" sort="Kitamoto, Kanako K" uniqKey="Kitamoto K" first="Kanako K." last="Kitamoto">Kanako K. Kitamoto</name><affiliation wicri:level="1"><nlm:aff id="A9">Endocrinology and Diabetes Centre, Yokohama Rosai Hospital, Yokohama 222-0036, Japan</nlm:aff><country xml:lang="fr">Japon</country><wicri:regionArea>Endocrinology and Diabetes Centre, Yokohama Rosai Hospital, Yokohama 222-0036</wicri:regionArea><wicri:noRegion>Yokohama 222-0036</wicri:noRegion></affiliation></author><author><name sortKey="Pham, Uyen" sort="Pham, Uyen" uniqKey="Pham U" first="Uyen" last="Pham">Uyen Pham</name><affiliation wicri:level="1"><nlm:aff id="A10">Endocrine Hypertension Research Centre, University of Queensland School of Medicine, Greenslopes and Princess Alexandra Hospitals, Brisbane, QLD, Australia</nlm:aff><country xml:lang="fr">Australie</country><wicri:regionArea>Endocrine Hypertension Research Centre, University of Queensland School of Medicine, Greenslopes and Princess Alexandra Hospitals, Brisbane, QLD</wicri:regionArea><wicri:noRegion>QLD</wicri:noRegion></affiliation></author><author><name sortKey="Morimoto, Ryo" sort="Morimoto, Ryo" uniqKey="Morimoto R" first="Ryo" last="Morimoto">Ryo Morimoto</name><affiliation wicri:level="1"><nlm:aff id="A6">Division of Clinical Hypertension, Endocrinology and Metabolism, Tohoku University Graduate School of Medicine, Sendai, Japan</nlm:aff><country xml:lang="fr">Japon</country><wicri:regionArea>Division of Clinical Hypertension, Endocrinology and Metabolism, Tohoku University Graduate School of Medicine, Sendai</wicri:regionArea><wicri:noRegion>Sendai</wicri:noRegion></affiliation></author><author><name sortKey="Umakoshi, Hironobu" sort="Umakoshi, Hironobu" uniqKey="Umakoshi H" first="Hironobu" last="Umakoshi">Hironobu Umakoshi</name><affiliation wicri:level="1"><nlm:aff id="A11">Department of Endocrinology, Metabolism and Hypertension, Clinical Research Institute, National Hospital Organization Kyoto Medical Centre, Kyoto, Japan</nlm:aff><country xml:lang="fr">Japon</country><wicri:regionArea>Department of Endocrinology, Metabolism and Hypertension, Clinical Research Institute, National Hospital Organization Kyoto Medical Centre, Kyoto</wicri:regionArea><wicri:noRegion>Kyoto</wicri:noRegion></affiliation></author><author><name sortKey="Prejbisz, Aleksander" sort="Prejbisz, Aleksander" uniqKey="Prejbisz A" first="Aleksander" last="Prejbisz">Aleksander Prejbisz</name><affiliation wicri:level="1"><nlm:aff id="A12">Department of Cardiology, Medical University of Wrocław, Wrocław, Poland</nlm:aff><country xml:lang="fr">Pologne</country><wicri:regionArea>Department of Cardiology, Medical University of Wrocław, Wrocław</wicri:regionArea><wicri:noRegion>Wrocław</wicri:noRegion></affiliation></author><author><name sortKey="Kocjan, Tomaz" sort="Kocjan, Tomaz" uniqKey="Kocjan T" first="Tomaz" last="Kocjan">Tomaz Kocjan</name><affiliation wicri:level="1"><nlm:aff id="A13">Department of Endocrinology, Diabetes and Metabolic Diseases, University Medical Centre Ljubljana, Ljubljana, Slovenia</nlm:aff><country xml:lang="fr">Slovénie</country><wicri:regionArea>Department of Endocrinology, Diabetes and Metabolic Diseases, University Medical Centre Ljubljana, Ljubljana</wicri:regionArea><wicri:noRegion>Ljubljana</wicri:noRegion></affiliation></author><author><name sortKey="Naruse, Mitsuhide" sort="Naruse, Mitsuhide" uniqKey="Naruse M" first="Mitsuhide" last="Naruse">Mitsuhide Naruse</name><affiliation wicri:level="1"><nlm:aff id="A11">Department of Endocrinology, Metabolism and Hypertension, Clinical Research Institute, National Hospital Organization Kyoto Medical Centre, Kyoto, Japan</nlm:aff><country xml:lang="fr">Japon</country><wicri:regionArea>Department of Endocrinology, Metabolism and Hypertension, Clinical Research Institute, National Hospital Organization Kyoto Medical Centre, Kyoto</wicri:regionArea><wicri:noRegion>Kyoto</wicri:noRegion></affiliation></author><author><name sortKey="Stowasser, Michael" sort="Stowasser, Michael" uniqKey="Stowasser M" first="Michael" last="Stowasser">Michael Stowasser</name><affiliation wicri:level="1"><nlm:aff id="A10">Endocrine Hypertension Research Centre, University of Queensland School of Medicine, Greenslopes and Princess Alexandra Hospitals, Brisbane, QLD, Australia</nlm:aff><country xml:lang="fr">Australie</country><wicri:regionArea>Endocrine Hypertension Research Centre, University of Queensland School of Medicine, Greenslopes and Princess Alexandra Hospitals, Brisbane, QLD</wicri:regionArea><wicri:noRegion>QLD</wicri:noRegion></affiliation></author><author><name sortKey="Nishikawa, Tetsuo" sort="Nishikawa, Tetsuo" uniqKey="Nishikawa T" first="Tetsuo" last="Nishikawa">Tetsuo Nishikawa</name><affiliation wicri:level="1"><nlm:aff id="A9">Endocrinology and Diabetes Centre, Yokohama Rosai Hospital, Yokohama 222-0036, Japan</nlm:aff><country xml:lang="fr">Japon</country><wicri:regionArea>Endocrinology and Diabetes Centre, Yokohama Rosai Hospital, Yokohama 222-0036</wicri:regionArea><wicri:noRegion>Yokohama 222-0036</wicri:noRegion></affiliation></author><author><name sortKey="Young, William F" sort="Young, William F" uniqKey="Young W" first="William F" last="Young">William F. Young</name><affiliation wicri:level="2"><nlm:aff id="A14">Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Internal Medicine, Mayo Clinic, Rochester, MN 55902, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Internal Medicine, Mayo Clinic, Rochester, MN 55902</wicri:regionArea><placeName><region type="state">Minnesota</region></placeName></affiliation></author><author><name sortKey="Gomez Sanchez, Celso E" sort="Gomez Sanchez, Celso E" uniqKey="Gomez Sanchez C" first="Celso E." last="Gomez-Sanchez">Celso E. Gomez-Sanchez</name><affiliation wicri:level="2"><nlm:aff id="A15">Division of Endocrinology, Department of Medicine, The University of Mississippi Medical Centre, Jackson, MS, USA; Research and Medicine Services, G.V. (Sonny) Montgomery VA Medical Centre, Jackson, MS, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Division of Endocrinology, Department of Medicine, The University of Mississippi Medical Centre, Jackson, MS, USA; Research and Medicine Services, G.V. (Sonny) Montgomery VA Medical Centre, Jackson, MS</wicri:regionArea><placeName><region type="state">État du Mississippi</region></placeName></affiliation></author><author><name sortKey="Funder, John W" sort="Funder, John W" uniqKey="Funder J" first="John W" last="Funder">John W. Funder</name><affiliation wicri:level="1"><nlm:aff id="A16">Hudson Institute of Medical Research and Monash University, Clayton, VIC , Australia</nlm:aff><country xml:lang="fr">Australie</country><wicri:regionArea>Hudson Institute of Medical Research and Monash University, Clayton, VIC </wicri:regionArea><wicri:noRegion>VIC </wicri:noRegion></affiliation></author><author><name sortKey="Reincke, Martin" sort="Reincke, Martin" uniqKey="Reincke M" first="Martin" last="Reincke">Martin Reincke</name><affiliation wicri:level="4"><nlm:aff id="A1">Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Ludwig-Maximilians-Universität München, Munich, Germany</nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Ludwig-Maximilians-Universität München, Munich</wicri:regionArea><placeName><region type="land" nuts="1">Bavière</region><region type="district" nuts="2">District de Haute-Bavière</region><settlement type="city">Munich</settlement><settlement type="city">Munich</settlement></placeName><orgName type="university">Université Louis-et-Maximilien de Munich</orgName></affiliation></author></analytic><series><title level="j">The lancet. Diabetes & endocrinology</title><idno type="ISSN">2213-8587</idno><idno type="eISSN">2213-8595</idno><imprint><date when="2017">2017</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec id="S1"><title>Background</title><p id="P1">Although unilateral primary aldosteronism is the most common surgically correctable cause of hypertension there are no standard criteria to classify surgical outcomes.</p></sec><sec id="S2"><title>Methods</title><p id="P2">The Primary Aldosteronism Surgical Outcome study reached consensus by an international panel of 31 experts, including 6 endocrine surgeons, using the Delphi method. On the basis of standardised criteria, remission (complete, partial, absent) rates for clinical and biochemical outcomes were determined in retrospective cohorts (n=30-99) of consecutive patients unilaterally adrenalectomized based on adrenal venous sampling from 12 tertiary centres in 9 countries over 4 continents.</p></sec><sec id="S3"><title>Findings</title><p id="P3">Consensus was reached for 6 criteria of clinical and biochemical outcome and 2 recommendations for follow-up. Complete clinical success was achieved in 37% of patients, with a wide variance (17-62%), and partial clinical success in an additional 47% (35-66%); complete biochemical success was seen in 94% (83-100%). Female patients had a higher likelihood of complete clinical success (OR=2.25; 95% CI, 1.40-3.62) and clinical benefit (complete + partial clinical success) (OR=2.89; 95% CI, 1.49-5.59). Younger patients had a higher likelihood of complete clinical success (OR=0.95 per extra year; 95% CI, 0.93-0.98) and clinical benefit (OR=0.95 per extra year; 95% CI, 0.92-0.98). Higher levels of pre-operative medication were associated with lower levels of complete clinical success.</p></sec><sec id="S4"><title>Interpretation</title><p id="P4">Standardised outcome criteria are relevant for evaluating the quality of surgical treatment in individual patients and will allow the comparison of outcome data in clinical and scientific studies. The baseline clinical characteristics of a cohort contribute to the wide variation in clinical outcome rates. A majority of patients derive clinical benefit from adrenalectomy with younger patients and female patients likely to particularly benefit from a favourable surgical outcome. Screening for primary aldosteronism should nonetheless be performed in every individual fulfilling the Guideline criteria, since biochemical cure is by itself clinically important and older women and men may also derive post-operative clinical benefit.</p></sec></div></front></TEI><affiliations><list><country><li>Allemagne</li><li>Australie</li><li>France</li><li>Italie</li><li>Japon</li><li>Pays-Bas</li><li>Pologne</li><li>Slovénie</li><li>États-Unis</li></country><region><li>Bavière</li><li>Berlin</li><li>District de Dresde</li><li>District de Haute-Bavière</li><li>Gueldre</li><li>Minnesota</li><li>Piémont</li><li>Saxe (Land)</li><li>État du Mississippi</li><li>Île-de-France</li></region><settlement><li>Berlin</li><li>Dresde</li><li>Munich</li><li>Nimègue</li><li>Paris</li><li>Turin</li></settlement><orgName><li>Université Louis-et-Maximilien de Munich</li><li>Université Paris-Descartes</li><li>Université technique de Dresde</li></orgName></list><tree><country name="Allemagne"><region name="Bavière"><name sortKey="Williams, Tracy A" sort="Williams, Tracy A" uniqKey="Williams T" first="Tracy A." last="Williams">Tracy A. Williams</name></region><name sortKey="Adolf, Christian" sort="Adolf, Christian" uniqKey="Adolf C" first="Christian" last="Adolf">Christian Adolf</name><name sortKey="Beuschlein, Felix" sort="Beuschlein, Felix" uniqKey="Beuschlein F" first="Felix" last="Beuschlein">Felix Beuschlein</name><name sortKey="Lenders, Jacques Wm" sort="Lenders, Jacques Wm" uniqKey="Lenders J" first="Jacques Wm" last="Lenders">Jacques Wm Lenders</name><name sortKey="Quinkler, Marcus" sort="Quinkler, Marcus" uniqKey="Quinkler M" first="Marcus" last="Quinkler">Marcus Quinkler</name><name sortKey="Reincke, Martin" sort="Reincke, Martin" uniqKey="Reincke M" first="Martin" last="Reincke">Martin Reincke</name><name sortKey="Rottenkolber, Marietta" sort="Rottenkolber, Marietta" uniqKey="Rottenkolber M" first="Marietta" last="Rottenkolber">Marietta Rottenkolber</name></country><country name="Italie"><region name="Piémont"><name sortKey="Williams, Tracy A" sort="Williams, Tracy A" uniqKey="Williams T" first="Tracy A." last="Williams">Tracy A. Williams</name></region><name sortKey="Burrello, Jacopo" sort="Burrello, Jacopo" uniqKey="Burrello J" first="Jacopo" last="Burrello">Jacopo Burrello</name><name sortKey="Mulatero, Paolo" sort="Mulatero, Paolo" uniqKey="Mulatero P" first="Paolo" last="Mulatero">Paolo Mulatero</name></country><country name="Pays-Bas"><region name="Gueldre"><name sortKey="Lenders, Jacques Wm" sort="Lenders, Jacques Wm" uniqKey="Lenders J" first="Jacques Wm" last="Lenders">Jacques Wm Lenders</name></region><name sortKey="Deinum, Jaap" sort="Deinum, Jaap" uniqKey="Deinum J" first="Jaap" last="Deinum">Jaap Deinum</name></country><country name="Japon"><noRegion><name sortKey="Satoh, Fumitoshi" sort="Satoh, Fumitoshi" uniqKey="Satoh F" first="Fumitoshi" last="Satoh">Fumitoshi Satoh</name></noRegion><name sortKey="Kitamoto, Kanako K" sort="Kitamoto, Kanako K" uniqKey="Kitamoto K" first="Kanako K." last="Kitamoto">Kanako K. Kitamoto</name><name sortKey="Morimoto, Ryo" sort="Morimoto, Ryo" uniqKey="Morimoto R" first="Ryo" last="Morimoto">Ryo Morimoto</name><name sortKey="Naruse, Mitsuhide" sort="Naruse, Mitsuhide" uniqKey="Naruse M" first="Mitsuhide" last="Naruse">Mitsuhide Naruse</name><name sortKey="Nishikawa, Tetsuo" sort="Nishikawa, Tetsuo" uniqKey="Nishikawa T" first="Tetsuo" last="Nishikawa">Tetsuo Nishikawa</name><name sortKey="Umakoshi, Hironobu" sort="Umakoshi, Hironobu" uniqKey="Umakoshi H" first="Hironobu" last="Umakoshi">Hironobu Umakoshi</name></country><country name="France"><region name="Île-de-France"><name sortKey="Amar, Laurence" sort="Amar, Laurence" uniqKey="Amar L" first="Laurence" last="Amar">Laurence Amar</name></region></country><country name="Australie"><noRegion><name sortKey="Pham, Uyen" sort="Pham, Uyen" uniqKey="Pham U" first="Uyen" last="Pham">Uyen Pham</name></noRegion><name sortKey="Funder, John W" sort="Funder, John W" uniqKey="Funder J" first="John W" last="Funder">John W. Funder</name><name sortKey="Stowasser, Michael" sort="Stowasser, Michael" uniqKey="Stowasser M" first="Michael" last="Stowasser">Michael Stowasser</name></country><country name="Pologne"><noRegion><name sortKey="Prejbisz, Aleksander" sort="Prejbisz, Aleksander" uniqKey="Prejbisz A" first="Aleksander" last="Prejbisz">Aleksander Prejbisz</name></noRegion></country><country name="Slovénie"><noRegion><name sortKey="Kocjan, Tomaz" sort="Kocjan, Tomaz" uniqKey="Kocjan T" first="Tomaz" last="Kocjan">Tomaz Kocjan</name></noRegion></country><country name="États-Unis"><region name="Minnesota"><name sortKey="Young, William F" sort="Young, William F" uniqKey="Young W" first="William F" last="Young">William F. Young</name></region><name sortKey="Gomez Sanchez, Celso E" sort="Gomez Sanchez, Celso E" uniqKey="Gomez Sanchez C" first="Celso E." last="Gomez-Sanchez">Celso E. Gomez-Sanchez</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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