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Michio Otsuki
Department School of Medicine(Tokyo Women's Medical University Hospital), School of Medicine Position Professor and Division head |
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| Article types | Original article |
| Language | English |
| Peer review | Peer reviewed |
| Title | Clinical Characteristics and Postoperative Outcomes of Primary Aldosteronism in the Elderly. |
| Journal | Formal name：The Journal of clinical endocrinology and metabolism Abbreviation：J Clin Endocrinol Metab ISSN code：19457197/0021972X |
| Domestic / Foregin | Foregin |
| Volume, Issue, Page | 103(10),pp.3620-3629 |
| Author and coauthor | Takeda Masao, Yamamoto Koichi, Akasaka Hiroshi, Rakugi Hiromi, Naruse Mitsuhide, Takeda Yoshiyu, Kurihara Isao, Itoh Hiroshi, Umakoshi Hironobu, Tsuiki Mika, Ichijo Takamasa, Katabami Takuyuki, Wada Norio, Shibayama Yui, Yoshimoto Takanobu, Ogawa Yoshihiro, Kawashima Junji, Sone Masakatsu, Inagaki Nobuya, Takahashi Katsutoshi, Fujita Megumi, Watanabe Minemori, Matsuda Yuichi, Kobayashi Hiroki, Shibata Hirotaka, Kamemura Kohei, Otsuki Michio, Fujii Yuichi, Ogo Atsushi, Okamura Shintaro, Miyauchi Shozo, Yanase Toshihiko, Suzuki Tomoko, Kawamura Takashi, |
| Publication date | 2018/10 |
| Summary | Context:Primary aldosteronism (PA) in the elderly has increased in importance in association with population aging.Objective:To investigate the characteristics and outcomes of elderly patients with PA undergoing adrenalectomy.Patients and Methods:Using a database of patients with PA who underwent adrenal venous sampling (AVS), we compared elderly patients (≥65 years old) with nonelderly patients (<65 years old) in terms of characteristics, subtype classification in ACTH-stimulated AVS, and outcomes after adrenalectomy.Results:The elderly group had a higher prevalence of comorbidities than the nonelderly group. The proportion of the unilateral subtype [defined as a lateralization index (LI) >4] was comparable between the age groups. In patients who received adrenalectomy, biochemical cure was comparable between the groups, whereas persistent hypertension was more common in the elderly group. The prevalences of hyperkalemia and renal impairment (chronic kidney disease stage 3b or higher) were higher in the elderly group. Multiple regression analysis showed that the duration of hypertension predicted persistent hypertension and hyperkalemia and that preoperative estimated glomerular filtration rate predicted renal impairment in the elderly group. LI >4 in AVS was an independent predictor of biochemical cure after adrenalectomy in the elderly group but not in the nonelderly group. Age was negatively associated with biochemical cure in patients with LI ≤4.Conclusion:Adrenalectomy contributes to biochemical improvement in elderly patients if determined in accordance with AVS. The treatment strategy should be determined considering the high postoperative incidence of persistent hypertension and hyperkalemia in elderly patients with a long history of hypertension or renal impairment in those with reduced renal function. |
| DOI | 10.1210/jc.2018-00059 |
| PMID | 30099522 |