6744 Clinical Profile And Outcomes Of Medically And Surgically Managed Patient With Primary Hyperaldosteronism In A Third-World World Setting
Authors: Apa-ap Archimedes A , Pacheco Elizabeth P 
Published: October 2024

Abstract
Disclosure: A.A. Apa-ap: None. E.P. Pacheco: None.
Background: Assessing therapeutic response in Primary hyperaldosteronism (PA) has previously been significantly hampered by a lack of standardized outcome markers. Although most participants in observational studies benefit from both medical and surgical therapy, comparative analyses have been limited. To date, no available Filipino data comparing therapeutic responses have been published. This paper aims to answer the clinical profile and outcomes of patients with PA in a third-world setting. Method: This is a retrospective cohort study that includes adult patients diagnosed with PA in the Philippine General Hospital seen at the outpatient department and admitted from January 1, 2013, until December 31, 2022. Result: 57 patients with PA were identified on chart review. A total of 40 (70%) patients were included in the study. 17 patients were excluded due to missing data. All patients had a unilateral adrenal mass. 23 patients underwent adrenalectomy and grouped under surgical management. 17 patients were treated with antihypertensive including MRA and grouped under medical management. Out of the 40 patients included: 83% were women, mean age was 40, hypertension averaged 6 years and 92.5% had hypokalemia. Radiologic profile showed mean tumor size 1.7cm and and mean tumor density 11.7 HU, mean absolute washout of 68.8 HU, and mean relative washout 54.8 HU. Comparing the post-treatment clinical outcome between surgical and medical management showed that patients who underwent surgical treatment had significantly lower systolic (difference=-11.12, p=0.0012) and diastolic blood pressure (difference= -6.03, p=0.0264), mean number of antihypertensive medication (difference= -2.30, p&lt;0.001), mean daily dose of antihypertensive(difference= -3.43, p&lt;0.001). Both groups had normal serum K post-treatment, but patients who underwent surgical treatment had significantly higher mean serum K (difference= 0.41, p=0.0025) and none had required MRA post-op. There was a lower number of patients with left ventricular hypertrophy and a significantly higher ejection fraction (difference= 5.81, p=0.0038) post-op compared to patients who underwent medical management. In terms of biochemical profile, there was a significantly lower mean plasma aldosterone concentration (difference= -31.95, p&lt;0.001), and mean aldosterone/renin activity (difference= -211.51, p=0.0013) and significantly higher mean plasma renin activity (difference= 0.43, p&lt;0.001) after surgery compared to those who underwent medical management. All surgical patients had a histopathologic diagnosis of adrenocortical adenoma. 9 patients complete clinical success and 14 had partial clinical success post-op; 22 had complete biochemical success and 1 had partial biochemical success based on PASO consensus. Conclusion: This study showed better clinical outcomes in patients with PA who underwent surgical management.
Presentation: 6/1/2024