SUN-460 Comparison of Clinical Outcomes and Quality of Life Between Mineralocorticoid Receptor Antagonists and Adrenalectomy in Patients With Unilateral Primary Aldosteronism

Abstract Disclosure: Y. Yoshida: None. K. Sada: None. T. Noguchi: None. N. Matsuda: None. S. Nagai: None. Y. Mori: None. N. Imaishi: None. M. Morita: None. S. Miyamoto: None. Y. Ozeki: None. K. Gotoh: None. T. Masaki: None. H. Shibata: Bayer, Inc., Daiichi Sankyo. Purpose: Primary aldosteronism (PA) has different treatment strategies depending on its subtype. Unilateral PA (uPA) is recommended to be treated by adrenalectomy (ADX), while mineralocorticoid receptor antagonists (MRAs) are the treatment of choice when surgery is not desired or not possible. There have been several studies that have attempted to determine which treatment is appropriate for uPA, but almost all have been observational and retrospective studies and the reasons for treatment selection are unclear. In this study, we evaluated whether ADX or MRAs were more effective in the same patients with uPA over time, including quality of life (QOL). Methods: A prospective observational study was conducted on 20 patients diagnosed with uPA, treated with MRAs until surgery, and then treated with ADX after MRAs. Blood pressure (BP), serum potassium (K), estimated glomerular filtration rate, plasma aldosterone concentration (PAC), active renin concentration (ARC), aldosterone-renin ratio (ARR), and QOL using 36-Item Short Form Survey (SF-36) were evaluated at three points: before treatment, immediately before ADX after MRAs, and 3 months after ADX. Results: Each data are shown as mean ± standard deviation at before treatment, after MRA treatment and before ADX, and 3 months after ADX. The patients were 51.7 ± 9.5 years old, 10 males and 10 females, and duration of MRA treatment was 79.2 ± 49.3 days. ADX improved systolic BP (140 ± 18, 128 ± 12, 121 ± 10 mmHg, p < 0.01) and serum K (3.1 ± 0.5, 4.0 ± 0.4, 4.5 ± 0.4 mmol/L, p = 0.02) the most in uPA patients, while MRA treatment also improved, but less than ADX. PAC and ARR were decreased only in ADX, and ARC was increased in ADX and MRAs, but did not differ by treatment. QOL was significantly improved in general health and vitality only with ADX. Conclusion: This is the first study to compare the treatment effects of ADX and MRAs over time, including QOL, in the same patients with uPA. ADX improved systolic BP, serum K levels, and mental QOL more than MRAs. Presentation: Sunday, July 13, 2025