Quality of Life in Patients with Bilateral Primary Aldosteronism before and during Treatment with Spironolactone and/or Amiloride, Including a Comparison with Our Previously Published Results in Those with Unilateral Disease Treated Surgically

Background: Measurement of quality of life (QOL) allows assessment of the impact of a disease or treatment from the patient's perspective, including need for social, emotional, or physical support. We are not aware of any published QOL assessment in patients with bilateral primary aldosteronism (BPA), before or after commencing medical treatment (MT) with spironolactone and/or amiloride. Methods: Using the internationally validated Medical Outcomes Study Short Form 36 General Health Survey (SF-36), QOL was assessed in 21 patients with BPA at baseline (time of diagnosis), and at 3 and 6 months after commencing MT. QOL scores at baseline were compared with published normative values for the Australian population. The results of the current study were compared with those from our previous study showing reduced QOL in patients with unilateral primary aldosteronism (UPA) with normalization by 3 months after unilateral laparoscopic adrenalectomy. Results: Compared with the general population, patients with BPA showed significant reduction (P < 0.01) in four QOL domains-physical functioning, role limitations due to physical health problems, general health perceptions, and vitality. After 6 months (but not 3 months) of MT, statistically significant (P < 0.05) improvements were detected in all these domains of QOL. When compared with patients with UPA treated surgically, scores were significantly (P < 0.05) lower at 3 months for five domains (role limitations due to physical health, general health, role limitations due to emotional health, mental health, and vitality) but at 6 months for only one domain (role limitations due to emotional problems). Conclusion: Subnormal QOL scores were improved after 6 months of MT in 21 patients with BPA, but more slowly and to a lesser degree than surgical treatment had previously been shown to improve QOL scores in 22 patients with UPA. (J Clin Endocrinol Metab 96: 2904-2911, 2011)