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The following is a summary of “A New Disease Severity Score for Measuring Treatment Response to Adrenalectomy in Patients With Primary Aldosteronism,” published in the September 2024 issue of Endocrinology by Akgun et al.

Cure rates following adrenalectomy for primary aldosteronism have been documented to range between 15% and 40%, highlighting a significant challenge in achieving optimal patient outcomes. Furthermore, existing criteria for defining cures need to be updated, leading to a need for more precise measures of treatment response. This study aims to evaluate the rate of cure based on a contemporary definition of normal blood pressure while also establishing a novel disease severity score to quantitatively assess clinical improvement following adrenalectomy in patients with primary aldosteronism.

This retrospective single-center study analyzed data from patients who underwent adrenalectomy for primary aldosteronism from 2000 to 2023. The study incorporated key clinical parameters, including blood pressure measurements, defined daily doses of antihypertensive medications, and potassium supplementation, to develop the Primary Aldosteronism Disease Severity Score (PADSS). This score was calculated using preoperative and 6-month postoperative parameters to gauge the effectiveness of the surgical intervention.

A total of 201 patients were included in the analysis, with adrenal venous sampling guiding the adrenalectomy in 86.1% of cases. According to the new definition of normal blood pressure, the cure rate post-surgery was notably low at 7.5% (n = 15). However, the median PADSS significantly improved, decreasing from 16.3 (IQR: 13.6–19.9) preoperatively to 10 (IQR: 4.5–13.3) six months postoperatively. Remarkably, 90% (n = 180) of patients improved PADSS at the 6-month follow-up, with the median rate of improvement calculated at 33.3% (ranging from 13.8% to 56.6%).

These findings indicate that while the complete cure rates after adrenalectomy for primary aldosteronism remain low—mainly when assessed against the new criteria for normal blood pressure—a substantial majority of patients experience meaningful clinical improvement postoperatively. 

The introduction of the PADSS offers a valuable tool for clinicians to assess the benefits achieved through adrenalectomy, providing an objective framework for evaluating treatment outcomes. By refining the criteria for a cure and establishing a method for quantifying severity, this study contributes to the ongoing effort to enhance patient care in those afflicted with primary aldosteronism, emphasizing the need for continued research into optimizing surgical approaches and postoperative management strategies.

Source: sciencedirect.com/science/article/pii/S1530891X24006657