Abstract Body: Introduction: Primary aldosteronism (PA), a common secondary cause of hypertension, is characterized by blunted suppression of aldosterone during high sodium intake. PA is associated with treatment-resistant hypertension, greater cardiovascular-renal disease, and more metabolic disturbances than blood pressure (BP) matched controls. PA patients have higher levels of visceral fat and BMI (bilateral > unilateral) than hypertensive patients without PA. Adrenalectomy (ADX) is the treatment of choice when aldosterone overproduction is unilateral.
Hypothesis: Despite the proven relationship between PA and body size, weight loss following ADX has received little attention. We aim to examine if ADX leads to weight loss in unilateral PA and identify predictors of this outcome.
Methods: Using data from our institutional primary aldosteronism registry, we evaluated weight changes in 29 patients who underwent ADX for unilateral PA between 2015-2024. Weight change was compared pre-ADX and 1-3, 3-6, 6-12, and 12-24 months post-ADX. Patient factors (age, race, sex, BP, and adrenal vein results – cortisol, aldosterone, and lateralization index) were compared between those who did and did not lose weight. Statistical analyses were done using Wilcoxon rank sum exact and Fisher’s exact test.
Results: Of the 29 patients, 65.5% were White, 13.8% Black, 3.4% another race, 17.2% unreported; 51.7% were male, and the mean age was 57. Median weight loss was significantly different between pre-ADX and 1-3 months (median = 2.00 kg, interquartile range = [-4.0, 0.1]; p = 0.003) and 3-6 months (2.67 kg, [-5.7, 0.0], p = 0.002). However, the weight loss observed at later periods was not statistically significant: 6-12 months (2.0 kg, [-5.2, 2.2], p = 0.11) and 12-24 months (0.3 kg, [-6.5, 2.3], p = 0.33). Those who lost weight had a marginally higher change in adrenal vein cortisol response compared with those who gained weight (112 nmol/L, [100, 1094] vs. 0 nmol/L, [0, 101]; p = 0.08).
Conclusion: In unilateral PA, ADX results in modest early weight loss that is not sustained over time. A limitation is that later time periods were associated with less follow-up and consequent reduction in statistical power. A greater change in cortisol from pre- to post-ACTH stimulation in the resected adrenal gland was present in those losing weight post-ADX. Future studies should investigate fat loss and predictors of weight loss in larger cohorts.