Therapeutic outcomes with surgical and medical management for primary aldosteronism: protocol for a systematic review and meta-analysis

Aldo Rocca; Eleftheria Gkaniatsa; Maria Chiara Brunese; Eva Hessman; Andreas Muth; Bright I Nwaru; Oskar Ragnarsson; Emanuele Bobbio; Daniela Esposito

doi:10.1136/bmjopen-2023-072585

Therapeutic outcomes with surgical and medical management for primary aldosteronism: protocol for a systematic review and meta-analysis

BMJ Open. 2023 Jul 30;13(7):e072585. doi: 10.1136/bmjopen-2023-072585.

Authors

Aldo Rocca¹, Eleftheria Gkaniatsa^{2

3}, Maria Chiara Brunese¹, Eva Hessman⁴, Andreas Muth^{5

6}, Bright I Nwaru^{7

8}, Oskar Ragnarsson^{2

3}, Emanuele Bobbio^#^{9

10}, Daniela Esposito^#^{11

3}

Affiliations

¹ Department of Medicine and Health Science 'V Tiberio', University of Molise, Campobasso, Italy.
² Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
³ Department of Endocrinology, Sahlgrenska University Hospital, Gothenburg, Sweden.
⁴ Biomedical Library, Gothenburg University Library, University of Gothenburg, Gothenburg, Sweden.
⁵ Department of Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden.
⁶ Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
⁷ Krefting Research Centre, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
⁸ Wallenberg Centre for Molecular and Translational Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.
⁹ Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden.
¹⁰ Department of Molecular and Clinical Medicine, Institute of Medicine at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
¹¹ Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden daniela.esposito@gu.se.

^# Contributed equally.

Abstract

Introduction: Treatment strategies for primary aldosteronism (PA) include unilateral adrenalectomy and medical treatment with mineralocorticoid receptor (MR) antagonists. Whether these two different treatment strategies are comparable in mitigating the detrimental effect of PA on outcomes is still debated.

Objectives: The primary aim of this systematic review is to identify, appraise and synthesise existing literature comparing clinical outcomes after treatment in patients with PA.

Methods and analysis: A systematic and comprehensive search will be performed using PubMed, Web of Science and EMBASE, for studies published until December 2022. Observational and interventional studies will be eligible for inclusion. The quality of observational studies will be assessed using the Newcastle-Ottawa Scale, while interventional studies will be assessed using the Cochrane Effective Practice Organization of Care tool. The collected evidence will be narratively synthesised. We will perform meta-analysis to pool estimates from studies considered to be homogeneous. Reporting of the systematic review and meta-analysis will be in accordance with the Meta-analysis of Observational Studies in Epidemiology Preferred Reporting Items for Systematic reviews and Meta-Analysis guidelines.

Ethics and dissemination: As this study is based solely on the published literature, no ethics approval is required. This review will aim to provide some estimates on outcomes, including survival, rates of clinical and biochemical control, cardiovascular and cerebrovascular events, as well as data on quality of life and renal function, in patients with PA treated surgically or with MR antagonists. The study findings will be presented at scientific meetings and will be published in an international peer-reviewed scientific journal.

Prospero registration number: CRD42022362506.

Keywords: Adrenal disorders; Endocrine tumours; General endocrinology; Hypertension.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Humans
Hyperaldosteronism* / drug therapy
Hyperaldosteronism* / surgery
Meta-Analysis as Topic
Quality of Life*
Research Design
Review Literature as Topic
Systematic Reviews as Topic
Treatment Outcome