Primary Aldosteronism: Superselective Embolization vs. Laparoscopic Endocrine Curative Therapy

Primary hyperaldosteronism is caused by excessive aldosterone secretion caused by adrenal cortex disease, which leads to increased sodium and potassium discharge, increased fluid volume and inhibition of renin-angiotensin-aldosterone system. It is one of the common causes of secondary hypertension as clinical symptoms with hypertension, hypokalemia, hyperaldosterone and low renin. It accounts for 5% to 13% of people with hypertension. In addition to the impact of hypertension itself on the body, the endocrine hormone disorder and electrolyte imbalance associated with PA may also become independent risk factors for cardiovascular and cerebrovascular events, and the risk of stroke, atrial fibrillation and myocardial infarction is significantly higher than that of essential hypertension, so early detection and reasonable treatment are crucial. PA can be divided into 6 types according to the etiology, of which the most common is idiopathic aldosteronism (IHA) and aldosteronoma, accounting for 60% and 30% respectively, unilateral adrenal hyperplasia followed, the other subtypes are less common. Previous guidelines have recommended surgery and drug intervention as the main measures for the treatment of PA, while unilateral PA is preferred by surgery and laparoscopic adrenalectomy. However, surgical treatment also has many limitations: First, not all patients with surgical indications have the opportunity to undergo adrenal resection. Surgical treatment is not suitable for patients with difficult laparoscopic operation, such as obesity, serious abdominal adhesion due to previous surgical history, and high-risk surgery, such as cardiovascular and cerebrovascular diseases and emphysema. In addition, adrenal resection may lead to adrenal dysfunction, serious infection, retroperitoneal hematoma and many other adverse reactions. The efficacy and safety of superselective adrenal artery embolization as a new alternative therapy for PA intervention have been proved. The aim of this study was to compare the efficacy of adrenectomy and superselective adrenal artery embolization according to international PASO evaluation criteria, and to conduct a prospective, multicenter, randomized controlled study in Xinjiang to explore the potential of SAAE as a treatment.

• Changes in ambulatory blood pressure and baseline blood pressure [Time frame: 1 day, 1 month, 3 months, 6 months, 12 months, 18 months and 24 months]
• Change of the number of antihypertensive medications [Time frame: 1 day, 1 month, 3 months, 6 months, 12 months, 18 months and 24 months]
• Adverse events [Time frame: Reported throughout the study period. Approximately 2 years]
• Readmission rate [Time frame: Reported throughout the study period. Approximately 2 years]
• Change of blood electrolytes (K+, Na +) [Time frame: 1 day, 1 month, 3 months, 6 months, 12 months, 18 months and 24 months]
• Change of plasma aldosterone [Time frame: 1 day, 1 month, 3 months, 6 months, 12 months, 18 months and 24 months]
• Change of plasma cortisol [Time frame: 1 day, 1 month, 3 months, 6 months, 12 months, 18 months and 24 months]
• Change of plasma renin measured [Time frame: 1 day, 1 month, 3 months, 6 months, 12 months, 18 months and 24 months]
• Change of liver enzymes [Time frame: 1 day, 1 month, 3 months, 6 months, 12 months, 18 months and 24 months]
• Change of kidney function [Time frame: 1 day, 1 month, 3 months, 6 months, 12 months, 18 months and 24 months]
• Change of fasting blood glucose [Time frame: 1 day, 1 month, 3 months, 6 months, 12 months, 18 months and 24 months]
• Change of lipids profiles [Time frame: 1 day, 1 month, 3 months, 6 months, 12 months, 18 months and 24 months]