{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,11]],"date-time":"2026-01-11T01:48:00Z","timestamp":1768096080528,"version":"3.49.0"},"reference-count":30,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2023,7,31]],"date-time":"2023-07-31T00:00:00Z","timestamp":1690761600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Endocrinology"],"published-print":{"date-parts":[[2023,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>The clinical significance of immunohistochemistry (IHC) for unilateral primary aldosteronism (PA) has been unclear. Individualized follow\u2010up of PA patients could be in sight. Long\u2010term outcomes of patients, classified based on IHC, need further investigation. We aimed to assess long\u2010term clinical outcomes for unilateral PA, classifying patients based on IHC.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>A nationwide observational study, with up to 16 years follow\u2010up, executed in 2007\u20132016 at Landspitali University Hospital, tertiary referral center. Patients were diagnosed and treated in line with the current guidelines. Haematoxylin and eosin (H&amp;E) tissue slides were stained using CYP11B1 and \u2010B2 antibodies. All cases were re\u2010evaluated and classified according to the HISTALDO consensus. Outcomes were assessed using the PASO criteria.<\/jats:p><\/jats:sec><jats:sec><jats:title>Patients<\/jats:title><jats:p>All unilateral PA patients diagnosed in 2007\u20102016 in Iceland, 26 patients aged 28\u201373 years, who underwent adrenalectomy, were included.<\/jats:p><\/jats:sec><jats:sec><jats:title>Measurements<\/jats:title><jats:p>Aldosterone, renin, and cortisol values, use and dosage of antihypertensives, potassium supplementation, blood pressure and serum potassium pre\u2010intervention and throughout follow\u2010up, and histopathology results post\u2010adrenalectomy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Following IHC, an aldosterone\u2010producing nodule was seen in 12 adrenals, an aldosterone\u2010producing adenoma in 10 and multiple aldosterone\u2010producing micronodules in four. IHC altered histopathology from previous H&amp;E diagnosis in 23% (6\/26) of the patients. In total, 81% (21\/26) of the patients had partial clinical success. Eight percent (2\/26) of the patients needed potassium supplementation during follow\u2010up. In the classical group, the AVS results were more determinative with significantly higher lateralization index (median 10.1 vs. 5.3, <jats:italic>p<\/jats:italic>\u2009=\u2009.04) and more contralateral suppression (median nondominant ratio 0.4 vs. 1.0, <jats:italic>p<\/jats:italic>\u2009=\u2009.03). One out of five patients with complete clinical success at 12 months post\u2010op had severe relapse later, the other four were normotensive without antihypertensives for up to 10 years.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>We found IHC mandatory for accurate histopathologic diagnosis of PA. Our results support the importance of contralateral suppression when interpreting AVS results. Also, the study highlights the complicated assessment of clinical outcome and importance of aldosterone and renin measurements during follow\u2010up.<\/jats:p><\/jats:sec>","DOI":"10.1111\/cen.14958","type":"journal-article","created":{"date-parts":[[2023,8,1]],"date-time":"2023-08-01T04:47:19Z","timestamp":1690865239000},"page":"441-448","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Immunohistochemical staining seems mandatory for individualizing and shortening follow\u2010up in unilateral primary aldosteronism"],"prefix":"10.1111","volume":"99","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3735-4884","authenticated-orcid":false,"given":"Hrafnhildur","family":"Gunnarsdottir","sequence":"first","affiliation":[{"name":"Faculty of Medicine University of Iceland Reykjavik Iceland"},{"name":"Department of Internal Medicine Landspitali University Hospital Reykjavik 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