ArticleThe Journal of clinical endocrinology and metabolism2026
Mineralocorticoid Receptor Antagonist Pre-Adrenalectomy in Primary Aldosteronism.
Article in The Journal of clinical endocrinology and metabolism, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.
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Who cites it
4 citing papers in PubMed.
- Influence of body mass index on disease severity and treatment outcomes in primary aldosteronism.Journal of the Endocrine Society · 2026Article
- [Primary aldosteronism as an independent factor of kidney damage. Potential therapeutic strategies and research prospects].Problemy endokrinologii · 2026Review
- Perioperative management of patients with primary aldosteronism: a practical approach for the endocrinologist.Endocrine connections · 2026Review
- Mineralocorticoid Receptor Antagonist Pre-Adrenalectomy in Primary Aldosteronism.The Journal of clinical endocrinology and metabolism · 2026Article
Corrections and comments
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Authors and funding
37 authors.
Funding
Abstract
contextPerioperative use of mineralocorticoid receptor antagonists (MRA) in patients with unilateral primary aldosteronism (PA) awaiting surgery is not well standardized.
objectiveThe aim of this study was to compare the risk of postoperative complications and surgical outcomes between PA patients treated with MRA prior to adrenalectomy and those not pretreated.
methodsAdrenalectomized patients for unilateral PA from the SPAIN-ALDO registry, with clinical, hormonal, and treatment information before and after adrenalectomy, were analyzed.
resultsA total of 355 surgically treated patients were included; 76.9% (n = 273) received presurgical treatment with MRA (spironolactone [64.5%], eplerenone [35.5%]). Adrenalectomy was guided by lateralization at adrenal venous sampling in 33.5% of the overall cohort, and by imaging in all the other cases. Patients pretreated with MRA had longer duration of hypertension, higher prevalence of hypokalemia, and greater aldosterone concentrations than those not pretreated (n = 82). No differences in the rate of postsurgical hyperkalemia, hypoaldosteronism, renal function impairment, blood pressure changes, and biochemical outcomes were detected between groups in the immediate (≤30 days) and short-term (≤90 days) follow-up evaluations after surgery. At long-term follow-up (≥6 months), patients pretreated with MRA exhibited better postsurgical biochemical outcomes (81.7% had complete biochemical response vs 57.1% of non-pretreated patients; P = .004). In the multivariable analysis, the use of MRA prior to adrenalectomy was independently associated with a successful postsurgical biochemical response.
conclusionPreoperative MRA therapy can be safely introduced to control blood pressure and potassium levels in patients with PA awaiting surgery, without increasing the risk of postoperative hyperkalemia, hypoaldosteronism, renal impairment, or hypotension.
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