Joshua Lee
Research Mentor: Adina Turcu
Mentor Department: Internal medicine/Endocrinology (MEND), Medicine
Author(s): Joshua Lee, Peeradon Vibhatavata, Adina Turcu
Session: Session 4 (1:00 PM – 1:50 PM)
Presentation Type: Poster 21
Abstract
Background: Primary aldosteronism (PA) is a leading cause of hypertension and a major risk factor for cardiovascular morbidity. Most, but not all patients with lateralized PA on adrenal vein sampling (AVS) can be cured with adrenalectomy. In some patients, aldosterone-producing foci are distributed throughout the resected adrenal gland (non-classic) instead of being confined to a single dominant lesion (classic aldosterone producing adenoma). Non-classic pathology suggests that similar foci might be present in the contralateral gland, predisposing to residual autonomous aldosterone production after surgery, but data on histopathology associations with postoperative outcomes in patients with PA are limited. Objective: To determine whether CYP11B2 expression patterns are associated with biochemical cure after AVS-guided adrenalectomy in patients with lateralized PA. Methods: Patients with PA who underwent AVS–guided adrenalectomy between January 2015 and December 2024 were included. Resected adrenal tissues were evaluated by CYP11B2 immunohistochemistry (IHC) and classified as classical or nonclassical pathology according to the HISTALDO classification. Postoperative outcomes were assessed according to the Primary Aldosteronism Surgical Outcome (PASO) consensus. CYP11B2 IHC-guided next-generation sequencing was performed to identify aldosterone-driver mutations. Results: Of 146 patients, 115 (78.8%) had classical pathology and 31 (21.2%) had nonclassical pathology. Age, sex, and race did not differ between groups (all P>0.05). Patients with classical pathology had lower serum potassium levels (3.6 vs 3.8 mmol/L, P=0.04), were more likely to have an adrenal nodule on cross-sectional imaging (84.3% vs 61.3%, P<0.01) and demonstrated stronger lateralization at baseline and after cosyntropin stimulation (both P<0.01). Postoperatively, biochemical cure was more frequent in patients with classical pathology than in those with nonclassical pathology (89.3% vs 66.7%, P<0.01), and hypertension remission was also higher in the classical group (25.9% vs 6.5%, P=0.02). KCNJ5 and ATPase mutations were more common in classical pathology, whereas CACNA1D mutations predominated in nonclassical pathology (P<0.01). Conclusion: Postoperative biochemical cure of PA and hypertension remission were more frequent in patients with classical pathology. CACNA1D driver mutations were more commonly observed in patients with nonclassical pathology, suggesting an overlap with bilateral PA.
