Adrenalectomy, MRA improve QoL in primary aldosteronism
Both surgical (adrenalectomy) and medical (mineralocorticoid receptor antagonists [MRA]) treatments improve quality of life (QoL) in primary aldosteronism (PA), which highlights the importance of identifying these patients, according to a recent study.
In addition, better improvement in QoL is observed after adrenalectomy for suspected aldosterone-producing adenoma (APA) than after initiation of medical treatment for suspected bilateral adrenal hyperplasia (BAH). APA and BAH are two subtypes of PA.
A total of 184 patients with PA were included in this posthoc comparative effectiveness study within the Subtyping Primary Aldosteronism: A Randomized Trial Comparing Adrenal Vein Sampling and Computed Tomography Scan (SPARTACUS) trial. QoL was assessed at baseline and 6- and 1-year follow-up using two validated questionnaires: RAND 36-item Health Survey (RAND SF-36) and European Quality of Life‒5 Dimensions (EQ-5D).
Patients with PA, compared with the general population, had lower scores in seven of eight RAND SF-36 and both summary scores, as well as in three of five EQ-5D dimensions and the visual analogue scale at baseline.
Adrenalectomy demonstrated larger beneficial effects than those for MRAs for seven RAND SF-36 subscales, both summary scores and health change. For the EQ-5D, there was a difference in favour of adrenalectomy in two dimensions and the visual analogue scale.
In both surgical and medical treatments, most differences in QoL exceeded the minimally clinically important difference. After 1 year, almost all QoL measures had normalized for patients who underwent adrenalectomy. For those on MRAs, most QoL measures had improved but not all to the level of the general population.