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Primary aldosteronism and long-term outcomes using PAMO definition

Hypertension Research (2025)Cite this article

Abstract

Primary aldosteronism is the most common form of endocrine hypertension, traditionally managed with unilateral adrenalectomy for unilateral disease and medical therapy for bilateral forms. However, mineralocorticoid receptor antagonists are often poorly tolerated and less effective in preventing cardiovascular outcomes. In this international retrospective cohort study, we evaluated the clinical and biochemical outcomes of adrenal surgery in 56 patients with bilateral primary aldosteronism from six referral centers across five countries. Patients underwent either unilateral (n = 43) or bilateral (n = 13) adrenal surgery based on adrenal venous sampling and CT findings. At 6–12 months follow-up, a clinical benefit was observed in 81% of patients after unilateral surgery and 92% after bilateral surgery. Biochemical success was achieved in 65% and 85% of these groups, respectively. Similar benefits persisted beyond 12 months. Adrenal insufficiency occurred in 31% of patients after bilateral surgery but was transient in most cases. Histopathological analysis revealed bilaterally symmetric aldosterone-producing lesions in the majority of patients undergoing bilateral adrenalectomy, including adenomas, micronodules, and diffuse hyperplasia. Our findings suggest that adrenal surgery, including in selected bilateral disease, can result in favorable clinical and biochemical outcomes with an acceptable safety profile, challenging the prevailing paradigm of exclusive medical management for bilateral primary aldosteronism.

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Data availability

All datasets generated during and/or analyzed during the current study are not publicly available but are available from the corresponding author on reasonable request.

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Acknowledgements

We would like to thank the National Taiwan University Hospital, Taiwan’s National Health Research Institutes, Taiwan’s Ministry of Science and Technology. We thank Membership of the Taiwan Primary Aldosteronism Investigation (TAIPAI) Study Group (https://doi.org/10.6084/m9.figshare.21669929).

Funding

Neither I nor my co-authors have a conflict of interest that is relevant to the subject matter or materials included in this work.

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Authors and Affiliations

  1. Department of Internal Medicine, National Taiwan University, Hospital and National Taiwan University College of Medicine, Taipei, Taiwan

    Wen-Kai Chu, Chun-Fu Lai, Yen-Hung Lin & Vin-Cent Wu

  2. Primary Aldosteronism Center of National Taiwan University Hospital (PAC) and Taiwan Primary Aldosteronism Investigators (TAIPAI), Taipei, Taiwan

    Sufeng Chiang, Yen-Hung Lin, Ya-Li Chen & Vin-Cent Wu

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  1. Wen-Kai Chu
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Contributions

Wen-Kai Chu: Formal analysis, Visualization, Writing - original draft. Chun-Fu Lai: Data curation, Formal analysis, Methodology, Writing - review & editing. Sufeng Chiang: Methodology, Software, Validation, Data curation, Writing - review & editing. Yen-Hung Lin: Data curation, Formal analysis, Writing - review & editing. Ya-Li Chen: Project administration, Resources, Data curation, Validation. Vin-Cent Wu: Conceptualization, Data curation, Formal analysis, Methodology, Resources, Supervision, Validation, Visualization, Writing - review & editing.

Corresponding author

Correspondence to Vin-Cent Wu.

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The authors declare that they have no conflict of interest.

Ethics approval and consent to participate

This study complied with the Declaration of Helsinki and received approval from the Institutional Review Board of National Taiwan University Hospital, Taipei, Taiwan (No. 200611031 R). All experimental protocols research was approved by the Institute Research Ethical Committee of National Taiwan University Hospital (NTUH) (https://doi.org/10.6084/m9.figshare.21730985). All methods were carried out in accordance with relevant guidelines and regulations. Informed consent was obtained from all participants or their legal guardians.

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Chu, WK., Lai, CF., Chiang, S. et al. Primary aldosteronism and long-term outcomes using PAMO definition. Hypertens Res (2025). https://doi.org/10.1038/s41440-025-02324-7

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