Effect of unilateral adrenalectomy on the quality of life of patients with lateralized primary aldosteronism

Background. Previous studies reported that primary aldosteronism (PA) is associated with an increased prevalence of anxiety, depression and subnormal quality of life (QoL) scores that may be improved after surgical treatment. Aim of the Study. The aim of the study was to assess the impact of surgery on health-related QoL and depression status of patients suffering from PA, comparing the results with a control group of patients undergoing surgery for a non-secreting adrenal tumor. Materials and Methods. Data on QoL and depression status were prospectively collected, from January 2014 to October 2016, before, early after surgery (at 1 month) and at long term (at least 6 months) in patients with unilateral PA and in a control group of patients with non-secreting adrenal tumor submitted to unilateral transperitoneal laparoscopic adrenalectomy. QoL was assessed using the Short Form 36 (SF-36) Health Survey for Physical (PCS) and Mental Component (MCS); the depression status by a 20-item depression scale (DS) questionnaire. Results. Twenty-six PA patients and 15 controls were recruited. Biochemical cure of the disease was achieved following surgery in all PA patients; hypertension was cured in 31% of cases and improved in the remaining 69% of cases. No morbidity occurred in both groups. There were no significant differences between PA patients and controls concerning demographics, preoperative PCS, MCS and DS values. In patients with PA, MCS values improved at early (42.72±13.68 vs 51.56±9.03, p=0.0005) and long term follow up (42.72±13.68 vs 51.81±7.04, p<0.0001); also DS values improved at early (15.92±11.98 vs 8.3±8.8, p=0.0002) and long term follow up (15.92±11.98 vs 4.57± 6.11, p<0.0001). In PA patients PCS values significantly improved at long term follow up (51.02±8.04 vs 55.85±5.1, p=0.013). Also in controls an improvement of MCS and DS scores was found at early and long term follow up compared to preoperative values, while no significant differences in PCS were found. Conclusions. Both PA and non-secreting adrenal tumors affect health-related QoL, worsening MCS and DS scores. Adrenalectomy is effective in curing PA, and improving MCS and DS scores at early and long-term follow-up, in patients with PA and non-secreting adrenal tumors. In PA patient surgery also significantly improves PCS at long term follow up.