SUN-237 Clinical Outcomes after Adrenalectomy in Primary Aldosteronism

Abstract Disclosure: K. Zekarias: None. J. Kohlenberg: None. M. Johnston: None. S. Ikramuddin: None. Background: Previous studies have reported complete clinical cure, defined as normalization of blood pressure without antihypertensive medications, in 37-39% of patients (1-2) following adrenalectomy for primary aldosteronism (PA), based on the former blood pressure (BP) threshold of <140/90 mmHg. This study evaluated outcomes using the current guideline BP threshold of <130/80 mmHg. Methods: We performed a retrospective analysis using the Epic COSMOS database, a multi-institutional repository of de-identified electronic health records. Using International Classification of Disease (ICD) codes, we identified 1,320 patients who underwent laparoscopic adrenalectomy for primary aldosteronism between January 2013 and December 2024. Inclusion required preoperative aldosterone measurement and office BP readings within 6 months before and 6-18 months after surgery (n=1,098). After excluding patients with baseline BP <130/80 mmHg and no antihypertensive medications, 1,079 patients were analyzed. Results: In this cohort, the mean age was 53.0±11.9 years, 40% female, complete clinical success (blood pressure <130/80 mmHg without medications) was achieved in 16% (178/1079) of patients. Partial success, defined as reduction in antihypertensive medications, occurred in 57% (615/1079), while 17% (180/1079) remained on the same number of medications. Multivariate logistic regression analysis showed that more antihypertensive medications (p < 0.001), higher blood pressure (systolic p = 0.004, diastolic p = 0.010), and greater social vulnerability (p = 0.013) predicted lower clinical success. Age, gender, race, body mass index, stroke history, sleep apnea, baseline potassium, and glomerular filtration rate showed no significant associations (all p > 0.05).Our study has limitations inherent to EHR data analysis: documentation inconsistencies across institutions, incomplete data capture, and potential selection bias from analyzing only Epic-based healthcare facilities may limit result generalizability. Conclusions: When applying current BP guidelines, complete clinical success following adrenalectomy for PA occurs in a smaller proportion of patients than previously reported. These findings enable physicians to provide realistic expectations and emphasize the need for vigilant post-surgical BP monitoring and management.References: 1. Williams TA, et al; Primary Aldosteronism Surgery Outcome (PASO) investigators. Lancet Diabetes Endocrinol. 2017;5(9):689-699. 2. Marzano L, et al. Hypertens Res. 2024;47(3):721-734. Presentation: Sunday, July 13, 2025