Context:

A recent study found that preoperative mineralocorticoid receptor antagonist (MRA) therapy in patients with primary aldosteronism awaiting adrenalectomy is safe, showing no increased risk of postoperative complications such as hyperkalemia or renal decline. Conducted in Spain, the research analyzed 355 patients and determined that those receiving MRA treatment had better long-term biochemical outcomes, including a higher rate of biochemical cure compared to those who did not receive MRAs. The findings support the use of MRAs to optimize patient management before surgery, although the study's retrospective design may limit the generalizability of the results. Future clinical practices may incorporate these findings to enhance patient care in this population. The study was led by Jessica Goi and published in The Journal of Clinical Endocrinology & Metabolism.

Dive Deeper:

• The study involved a retrospective analysis of 355 patients diagnosed with primary aldosteronism, with an average diagnostic age of 52 years, of whom 45.6% were women. Out of these, 273 patients received MRA therapy (spironolactone or eplerenone) prior to adrenalectomy, while 82 did not.

• Clinical outcomes were evaluated at three follow-up intervals: immediate (≤ 30 days), short-term (≤ 90 days), and long-term (≥ 6 months), focusing on blood pressure, plasma aldosterone, and incidences of hyperkalemia and hypoaldosteronism.

• Before surgery, MRA-treated patients exhibited a longer median history of hypertension (9 years vs 6 years in non-pretreated patients) and a higher lifetime incidence of hypokalemia (80.2% vs 65.9%), with significant statistical implications.

• No significant differences in postoperative complications such as hyperkalemia or renal function decline were observed between the two groups at immediate and short-term follow-ups, indicating that MRA therapy does not adversely affect these outcomes.

• At long-term follow-up, patients pretreated with MRAs showed a biochemical cure rate of 81.7%, compared to 57.1% in the non-pretreated group, and had a lower prevalence of left ventricular hypertrophy, highlighting the benefits of MRA therapy.

• The study was conducted by Jessica Goi and associates at the Hospital Universitario Ramón y Cajal in Madrid, and its findings may influence future clinical guidelines on the management of patients with primary aldosteronism.

• Limitations of the study include its retrospective design, potential variations in treatment approaches between centers, and the lack of standardized laboratory assays, which could affect data reliability.