Comparative outcomes of adrenalectomy, mineralocorticoid receptor antagonist, and percutaneous adrenal ablation for primary aldosteronism: a systematic review and network meta-analysis

Abstract BACKGROUND Percutaneous adrenal ablation (PAA) is an effective and safe therapy for treating patients with primary aldosteronism (PA). However, its effectiveness in comparison to that of adrenalectomy (ADX) and mineralocorticoid receptor antagonists (MRAs) remains unclear. METHODS Databases were searched including: Pubmed, Embase, and The Cochrane Library. Studies were included if patients with PA who received two of three different treatments (ADX, MRAs, or PAA) and reported our interested outcomes, including blood pressure, serum potassium and the aldosterone-to-renin ratio (ARR). RESULTS In total of 10,681 patients from forty-seven studies were identified. Both ADX and PAA showed superior clinical success (systolic BP: ADX: -4.69 [-6.4, -2.95], PAA: -3.96 [-9.05, 0.99]; diastolic BP: ADX: -3.14 [-4.55, -1.85], PAA: -2.99 [-6.96, 0.98]) compared with MRAs. According to the Bayesian ranking curves (SUCRA values), ADX ranked first for all outcomes of interest (systolic BP: 81.02%, diastolic BP: 76.95%, serum potassium: 96.55%, and ARR: 88.03%), while PAA ranked second for all outcomes (systolic BP: 65.94%, diastolic BP: 69.66%, serum potassium: 50%, and ARR: 45.14%). CONCLUSIONS The findings of this network meta-analysis suggest that PAA could be an alternative treatment for patients with PA who are unable to opt for surgery or MRA therapy, and its clinical and biochemical success fall between those of ADX and MRAs.