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Citton, Marilisa (2016) Effect of unilateral adrenalectomy on the quality of life of patients with lateralized primary aldosteronism. [Ph.D. thesis]

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Abstract (english)

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.

Abstract (italian)

Presupposti dello studio. Studi precedenti hanno descritto che l’iperaldosteronismo primario (PA) è associato ad un aumento della prevalenza di ansia, depressione e peggioramento della qualità di vita (QoL), con miglioramento significativo dopo il trattamento chirurgico.
Scopo dello studio. Lo scopo dello studio è quello di indagare l’impatto della chirurgia sulla qualità di vita dei pazienti con PA, comparando i risultati con un gruppo di controllo costituito da pazienti sottoposti a surrenectomia per tumori surrenalici non secernenti.
Materiali e Metodi. I dati sulla qualità di vita e lo stato di depressione sono stati raccolti prospetticamente, da Gennaio 2014 a Ottobre 2016, preoperatoriamente, dopo 1 mese e dopo almeno 6 mesi dall’intervento chirurgico di surrenectomia laparoscopica transperitoneale in pazienti con PA lateralizzato e in un gruppo di controllo costituito da pazienti con tumori non-secernenti del surrene. La QoL è stata valutata utilizzando il questionario SF-36, per valutazione della componente fisica (PCS) e mentale (MCS); lo stato depressivo è stato quantificato utilizzando un questionario di valutazione della depressione (DS) costituito da 20 domande.
Risultati. Sono stati reclutati 26 pazienti con PA e 15 controlli. La cura biochimica della malattia è stata ottenuta in tutti i pazienti con PA; l'ipertensione è stata curata nel 31% dei casi ed è migliorata nel 69% dei casi. Non si sono verificate complicanze chirurgiche in entrambi i gruppi. Non sono state rilevate differenze statisticamente significative tra i pazienti con PA e i controlli per quanto riguarda i dati demografici e i valori preoperatori di PCS, MCS e DS. Nei pazienti con PA, i valori di MCS sono migliorati sia a 1 mese dall’intervento (42.72 ± 13.68 vs 51.56 ± 9.03, p = 0,0005) che a distanza (42,72 ± 13.68 vs 51.81 ± 7.04, p <0,0001). Nei pazienti affetti da PA anche i valori di DS sono migliorati sia a breve (15.92 ± 11.98 vs 8.3 ± 8.8, p = 0,0002) che a lungo termine (15,92 ± 11.98 vs 4.57 ± 6.11, p <0,0001); i valori di PCS sono migliorati significativamente solo a distanza dall’intervento (51.02 ± 8.04 vs 55.85 ± 5.1, p = 0,013). Anche nel gruppo di controllo i valori di MCS e DS sono migliorati sia a breve dopo l’intervento che a distanza; in questi pazienti non sono state rilevate variazioni significative nei valori di PCS dopo l’intervento.
Conclusioni. I pazienti affetti da PA e tumori surrenalici non-secernenti sono caratterizzati da una QoL peggiore rispetto alla popolazione normale. La surrenectomia è efficace nella cura del PA, e nel migliorare i punteggi di MCS e DS sia a 1 mese dall’intervento che a lungo termine, sia nei pazienti con PA che nel gruppo di controllo. Nei pazienti con PA, i valor di PCS migliorano significativamente solo a lungo termine.

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EPrint type:Ph.D. thesis
Tutor:Iacobone, Maurizio
Ph.D. course:Ciclo 29 > Corsi 29 > IPERTENSIONE ARTERIOSA E BIOLOGIA VASCOLARE
Data di deposito della tesi:19 January 2017
Anno di Pubblicazione:15 November 2016
Key Words:Primary aldosteronism / Iperaldosteronismo primario
Settori scientifico-disciplinari MIUR:Area 06 - Scienze mediche > MED/09 Medicina interna
Struttura di riferimento:Dipartimenti > Dipartimento di Medicina
Codice ID:9881
Depositato il:16 Nov 2017 09:41
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