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Войти в исследования A global real-world study assessing total time to adrenalectomy in primary aldosteronism.
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Ter Charmaine, Koh Xuan Han, Tran Hieu, Bancos Irina, Bassiony Mohamed, Araujo-Castro Marta, Paja Miguel, González Boillos Marga, Gkaniatsa Eleftheria, Reincke Martin, Adolf Christian, Tran Thang Viet, Stowasser Michael, Nayak Drishya, Grytaas Marianne A, Turcu Adina F, Matrozova Joanna, Sukor Norlela, Ismail Farhana, Kocjan Tomaz, Parasiliti-Caprino Mirko, Baudrand Rene, Uslar Thomas, Tsuiki Mika, Murakami Masanori, Yang Jun, Ng Chrislyn, Katabami Takuyuki, Naruse Mitsuhide, St-Jean Matthieu, Ceccato Filippo, Saffari Seyed Ehsan, Teo Ada E D, Puar Troy H
Аннотация
METHODS: We conducted an international, multicentre retrospective study involving 39 centres from 15 countries to determine the total time taken from the first presentation to adrenalectomy and the intervals between each stage (screening, confirmatory, subtyping, and adrenalectomy). We included patients with PA who underwent adrenalectomy from January 1, 2018, to October 30, 2022. Post-adrenalectomy outcomes were evaluated using the Primary Aldosteronism Surgery Outcome criteria. We performed multivariable quantile and linear regression to identify characteristics associated with longer TTA.
RESULTS: We included 861 patients, mean age 49.3 ± 11.1 years, and 44.5% were women. Overall median TTA was 13.5 months, IQR: 6.6-24.5. Median intervals were 0.1 months (screening), 1.0 months (confirmatory), 4.1 months (subtyping), and 4.3 months (adrenalectomy). On multivariable analysis, median TTA was increased by 5.4 months for each additional adrenal vein sampling (AVS) procedure. Other factors associated with longer TTA included adrenalectomy post-COVID-19, younger age, and additional screening tests. Compared with countries with routine AVS, those without AVS had a shorter TTA (6.1 vs 15.1 months, P < .001), but greater likelihood of absent/partial biochemical success post-adrenalectomy (27.4% vs 12.4%, P < .001).
CONCLUSION: Primary aldosteronism management is time-consuming worldwide, especially for subtyping tests and adrenalectomy. While omitting AVS reduces overall time, patients are less likely to achieve biochemical cure post-adrenalectomy.