Mineralocorticoid Receptor Antagonist Pre-Adrenalectomy in Primary Aldosteronism
Authors' conclusion
Preoperative MRA therapy can be safely introduced to control blood pressure and potassium levels in patients with PA awaiting surgery, without increasing the risk of postoperative hyperkalemia, hypoaldosteronism, renal impairment, or hypotension.
Study context
- Population
- Adrenalectomized patients with unilateral primary aldosteronism (PA) from the SPAIN-ALDO registry; adrenalectomy guided by AVS lateralization in 33.5%, by imaging in the others
- Participants
- 355 patients
- Exposure
- Mineralocorticoid receptor antagonists (MRA) pretreatment before adrenalectomy vs no pretreatment
- MRAn = 273
- Non-pretreatedn = 82reference
- Outcome
- Postoperative complications and surgical outcomes
Methodological detailsSPAIN-ALDO registry, multivariable analysis
- SPAIN-ALDO registry
- Multivariable analysis
Main finding
As reported in the abstract
Postsurgical hyperkalemia, hypoaldosteronism, renal function impairment, BP changes and biochemical outcomes · immediate (≤30 days) and short-term (≤90 days)
- No differences between groups
Observational data: associations, not effects.
Further findings
Complete biochemical response · long-term follow-up (≥6 months)
P = 0.004
Complete biochemical response · long-term follow-up (≥6 months)
- MRA use before adrenalectomy independently associated with successful postsurgical biochemical response (multivariable analysis)
Baseline characteristics
- MRA-pretreated had longer duration of hypertension, higher prevalence of hypokalemia and greater aldosterone concentrations than non-pretreated
Original publication
Mineralocorticoid Receptor Antagonist Pre-Adrenalectomy in Primary Aldosteronism. J Clin Endocrinol Metab. Published 4 October 2025. doi:10.
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