Zarnegar R et al. (2008) The aldosteronoma resolution score: predicting complete resolution of hypertension after adrenalectomy for aldosteronoma. Ann Surg 247: 511–518

Primary aldosteronism is commonly caused by an aldosterone-producing adenoma (APA). The primary role of adrenalectomy in the treatment of APA is to correct hypokalemia and improve blood pressure control. Although hypertension improves in >90% of patients after adrenalectomy, many continue to require antihypertensive medication. To help clinicians predict whether patients with APA who undergo adrenalectomy are likely to experience complete resolution of their hypertension, Zarnegar et al. developed and validated a prediction model based on data that are readily available to practicing clinicians.

The researchers identified clinical variables associated with the resolution of hypertension by examining data on 100 patients who underwent adrenalectomy for APA at a US tertiary referral center. This dataset was used to construct a multivariate prediction model and the predictive scores were validated in an independent dataset of 67 patients from another tertiary medical center in the US.

The best predictive model for complete resolution of hypertension after adrenalectomy used four variables (two or fewer antihypertensive medications, BMI ≤25 kg/m2, duration of hypertension ≤6 years, female sex). The resulting aldosteronoma-resolution score (ARS) identified three levels of likelihood (low, medium, high) for complete resolution of hypertension. A low ARS had a negative predictive value of 72.4%, whereas a high ARS had a positive predictive value of 75.0%.

The authors conclude that the ARS can help clinicians objectively inform patients about potential treatment outcomes before they undergo surgery.