Follow-up of patients with primary aldosteronism (PA): comparison of surgical and medical treatment

Primary aldosteronism (PA) is considered a frequent cause of hypertension. In
PA hypertension is often found to be refractory to common antihypertensive
drugs. Surgery has the potential to cure the disease with normalization of
blood pressure without medication. However an adrenalectomy is only indicated
in case of unilateral adrenal pathology; patients with bilateral adrenal
pathology need to be treated medically. Therefore, an accurate distinction
between the unilateral and bilateral type of PA is of utmost importance.
Differentiation between both forms is usually done using imaging techniques
such as CT/MRI or by means of adrenal venous sampling (AVS). However, results
of CT/MRI and AVS are discordant in 41% of patients; e.g. unilateral pathology
shown by CT/MRI whereas AVS indicates bilateral pathology, or vice versa, or
unilateral pathology shown by CT/MRI whereas AVS indicates that the
contralateral adrenal gland is affected. In general AVS is considered to be the
gold standard to accurately differentiate between unilateral and bilateral
adrenal pathology in PA and consequently, to accurately identify patients
eligible for adrenalectomy or medical treatment. However, only detailed
knowledge on long-term follow up results, in terms of severity of hypertension,
use of medication(s) and improvement of biochemical parameters, can identify
whether the decision to treat a patiënt with adrenalectomy has been legitimate.
To date, such detailed long-term follow up results are not available.

In this study we want to investigate long-term follow-up of patients with PA.
The outcome will be analyzed based on whether a decision to treat was guided by
CT/MRI or AVS or both.

Of all patients with PA, known in the UMCN St. Radboud, the medical file will
be examined to gather medical data. The patients who underwent an adrenalectomy
will be invited for a visit to the UMCN St. Radboud. During this visit
standardized blood pressure measurements will be done and a venapuncture will
be done to determine aldosterone, renin, potassium and creatinin.

For the operated patients who are not visiting the UMCN St. Radboud anymore,
participation involves an extra visit to our hospital. There are no risks for
the participating patients.