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. 2025 Feb;48(2):529-539.
doi: 10.1038/s41440-024-01946-7. Epub 2024 Oct 25.

Evaluating the effects of adrenalectomy and mineralocorticoid receptor antagonist on cardiac remodeling and diastolic function in patients with aldosterone-producing adenoma

Yu-Ching Chang  1 , Xue-Ming Wu  2 , Tsung-Yan Chen  3 , Uei-Lin Chen  1   4 , Che-Wei Liao  5 , Tai-Shuan Lai  6 , Chin-Chen Chang  7 , Bo-Ching Lee  7 , Fang-Yu Yang  1 , Zheng-Wei Chen  8 , Yi-Yao Chang  9   10 , Jeff S Chueh  11 , Vin-Cent Wu  6 , Cheng-Hsuan Tsai  12   13 , Chi-Sheng Hung  14   15 , Yen-Hung Lin  9   16 ; TAIPAI study group
Collaborators, Affiliations

Evaluating the effects of adrenalectomy and mineralocorticoid receptor antagonist on cardiac remodeling and diastolic function in patients with aldosterone-producing adenoma

Yu-Ching Chang et al. Hypertens Res. 2025 Feb.

Abstract

Cardiac remodeling and diastolic dysfunction in patients with aldosterone-producing adenomas (APA) can be improved after adrenalectomy. However, the effect of mineralocorticoid receptor antagonist (MRA) treatment remains unclear. The aim of this study is to evaluate the effect of MRA on cardiac remodeling and diastolic dysfunction in patients with PA. We prospectively enrolled patients with APA from 1993 to 2023, who either received medical treatment with MRAs or underwent adrenalectomy. Biochemical characteristics and echocardiographic findings were collected at baseline and one year after treatment. Propensity score matching was conducted based on baseline biochemical characteristics, left ventricular mass index (LVMI), and diastolic function. A total of 467 APA patients were enrolled in the study. After propensity score matching, 159 patients who underwent adrenalectomy were matched with 159 patients who received MRAs. After therapy, patients who received MRAs showed significant improvement in diastolic function after one year of treatment but not LVMI. Compared to the MRA group, the adrenalectomy group had greater improvement in systolic blood pressure, plasma aldosterone concentration, plasma renin activity, aldosterone-to-renin ratio, and LVMI. In multivariable regression analysis, pretreatment echocardiographic values were significantly associated with changes in both LVMI and E/e', while the treatment strategy showed a significant association with changes in LVMI. Thus, one year after therapy, both adrenalectomy and MRA are effective in improving diastolic function in patients with APA. However, adrenalectomy is more effective than MRA treatment in reversing cardiac remodeling in patients with APA.

Keywords: Adrenalectomy; Aldosterone-producing adenoma; Diastolic dysfunction; Left ventricular remodeling; Mineralocorticoid receptor antagonist.

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Conflict of interest statement

Compliance with ethical standards. Conflict of interest: The authors declare no competing interests.

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