Quality of Life in Primary Aldosteronism Improves more after Adrenalectomy than after Medical Therapy

Presentation Number: SUN 529
Date of Presentation: April 2nd, 2017

Marieke S. Velema1, Tanja Dekkers1, Ad R.M.M. Hermus1, Henri J.L.M. Timmers1, Jacques W.M. Lenders2, Hans J.M.M. Groenewoud1, Leo J. Schultze Kool1, Johannes F. Langenhuijsen1, Aleksander Prejbisz3, Gert-Jan van der Wilt1 and Jaap Deinum*1
1Radboud University Medical Center, Nijmegen, Netherlands, 2Department of Internal Medicine III, University Hospital Carl Gustav Carus, Technical University Dresden, Germany, 3Institute of Cardiology, Warsaw, Poland


In primary aldosteronism (PA) two main subtypes are distinguished: aldosterone-producing adenoma (APA) and bilateral adrenal hyperplasia (BAH). The generally accepted treatment for the former is adrenalectomy and for the latter mineralocorticoid receptor antagonists. Our aim was to compare the effects of surgical treatment (adrenalectomy) and medical treatment (mineralocorticoid receptor antagonists) on health-related quality of life (QoL) in patients with PA. This was done by a post-hoc comparative effectiveness study within the SPARTACUS study in twelve Dutch teaching and academic hospitals and one Polish hospital. The cohort comprised patients with PA (n=184) identified by a salt loading test. In case of aldosterone-producing adenoma we performed an adrenalectomy (n=92) and for bilateral adrenal hyperplasia we treated patients with mineralocorticoid receptor antagonists (n=92). At baseline, six months and one year follow-up we assessed QoL by the RAND 36-Item Health Survey 1.0 (RAND SF-36): eight subscales, physical and mental summary score and health change; and European Quality of Life-5 Dimensions (EQ-5D): five dimensions, index score and visual analogue scale. At baseline, seven out of eight RAND SF-36 subscales and both summary scores and three out of five EQ-5D dimensions and the visual analogue scale were lower in PA patients compared to the general population. After adjustment for baseline variables the beneficial effects of adrenalectomy were larger than for mineralocorticoid receptor antagonists for seven of the eight RAND SF-36 subscales, both summary scores, and health change. For the EQ-5D, we detected a difference in favour of adrenalectomy in two of the five dimensions and the visual analogue scale. One year after adrenalectomy all QoL measures had improved to the level of the general population. For patients on mineralocorticoid receptor antagonists most QoL measures had improved, but not all to the level of the general population. There was no difference in ambulatory blood pressure or potassium level between patients after adrenalectomy and patients on mineralocorticoid receptor antagonists. In conclusion, both treatments clearly improve QoL of patients with PA, underscoring the importance of identifying such patients. Improvement in QoL in PA patients one year after surgical treatment for aldosterone-producing adenoma is superior to that of medically treated patients with bilateral adrenal hyperplasia.