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A systematic review to compare adrenalectomy and mineralocorticoid receptor antagonists in patients with unilateral primary aldosteronism

Hypertension Research volume 48, pages 2368–2375 (2025)Cite this article

A Comment to this article was published on 22 August 2025

Abstract

To date, no systematic review has examined whether adrenalectomy (ADX) or mineralocorticoid receptor antagonist (MRA) treatment is more effective in patients with unilateral primary aldosteronism (uPA). Comparing clinical and biochemical data before and after treatment, we performed a systematic review to determine whether either ADX or MRA treatment is superior to the other in patients with uPA. Article search was performed using the PubMed, Cochrane Library, and ICHUSHI electronic databases. A comparative analysis was performed when at least 3 articles were available in each outcome. The collected data were used to calculate the effect measures represented as mean difference (MD) or odds ratio (OR). Our search strategy identified 526 abstracts, of which 7 research papers were finally included in the analysis. ADX for uPA patients significantly reduced the incidence of cerebro-cardiovascular disease (OR 0.63 [95% confidence interval 0.46, 0.85]), lowered the systolic BP (−8.78 mmHg [−11.61, −5.95]), and increased the serum potassium levels (0.43 mmol/L [0.35, 0.51]) compared to MRAs. In conclusion, ADX is more effective than MRA treatment in patients with uPA, but with higher risk of increased serum potassium levels.

Graphical abstract: ADX adrenalectomy, MRAs mineralocorticoid receptor antagonists, PA primary aldosteronism, SBP systolic blood pressure.

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Acknowledgements

We would like to thank all members involved in the creation of JSH2025 for their inspiring discussions and technical assistance.

Funding

YY received funding from Grand-in-Aid for the Intractable Adrenal Disorders Research by the Ministry of Health, Labour and Welfare 23FC1041. KK received funding from Terumo Life Science Foundation, The Grants for Basic Research of The Japanese Society of Hypertension, and The Salt Science Research Foundation.

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Author notes

  1. These authors contributed equally: Yuichi Yoshida, Kenichiro Kinouchi.

Authors and Affiliations

  1. Department of Endocrinology, Metabolism, Rheumatology and Nephrology, Faculty of Medicine, Oita University, Yufu, Japan

    Yuichi Yoshida & Satoshi Nagai

  2. Division of Endocrinology, Metabolism, and Nephrology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan

    Kenichiro Kinouchi

  3. Health Administration Center, University of the Ryukyus, Nishihara Okinawa, Japan

    Atsushi Sakima

  4. Department of Geriatric and General Medicine, Osaka University Graduate School of Medicine, Suita, Japan

    Yoichi Takami

  5. Department of Preventive Medicine & Public Health, Fukuoka University, Fukuoka, Japan

    Hisatomi Arima

  6. Department of Internal Medicine, International University of Health and Welfare Mita Hospital, Tokyo, Japan

    Kazutoshi Miyashita

  7. Department of Nephrology, Omuta Tenryo Hospital, Omuta, Japan

    Masashi Mukoyama

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Correspondence to Yuichi Yoshida or Kenichiro Kinouchi.

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Yoshida, Y., Kinouchi, K., Nagai, S. et al. A systematic review to compare adrenalectomy and mineralocorticoid receptor antagonists in patients with unilateral primary aldosteronism. Hypertens Res 48, 2368–2375 (2025). https://doi.org/10.1038/s41440-025-02273-1

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