Cardiometabolic Burden in Bilateral Macronodular Adrenal Disease With Primary Aldosteronism - PubMed

5 hours ago

Bilateral macronodular adrenocortical disease (BMAD) often involves primary aldosteronism (PA) and is associated with a high cardiometabolic burden.
The study included 249 patients from 41 centers across 12 countries, with a median age of 55 years and 62% male; median hypertension duration was 9.9 years at PA diagnosis.
Among tested patients, 52% had cortisol cosecretion and 47% had isolated PA; at baseline, 56% had metabolic comorbidities, and 16% had at least one major adverse cardiovascular event (MACE).
Patients with MACE were older, more often male, had longer hypertension duration, and higher diabetes rates.
Treatment outcomes showed MACE rates of 8% in MRA-treated patients and 6% in adrenalectomy patients over a median follow-up of 36 vs. 18 months, respectively, with no significant difference.
Adrenal venous sampling indicated lateralized PA in 89% of surgical patients versus 19% of MRA-treated patients.
Blood pressure and organ damage were similar between groups, but more MRA-treated patients required three or more antihypertensives (48% vs. 14% for adrenalectomy).
Among operated patients, complete clinical success was 26% and biochemical success was 71%.
Early detection and precise subtyping are crucial for optimizing management and preventing target organ damage in BMAD with PA.

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