Abstract
INTRODUCTION: Incomplete clinical success after unilateral adrenalectomy for primary aldosteronism (PA) remains a significant challenge, often characterized by persistent hypertension despite biochemical remission. OBJECTIVE: This study aimed to develop and validate a preoperative predictive nomogram to estimate the probability of incomplete clinical success in PA patients undergoing unilateral adrenalectomy. MATERIALS AND METHODS: A retrospective analysis was conducted on 58 PA patients who underwent adrenalectomy. Independent predictors of non-complete clinical success were identified using multivariate logistic regression. A nomogram was developed based on age, highest systolic blood pressure (SBP), and lateralization index (LI). Model performance was evaluated through the concordance index (C-index), calibration plots, and decision curve analysis, with internal validation performed via bootstrapping (1,000 resamples). RESULTS: Age (OR 1.117), highest SBP (OR 1.241), and LI (OR 1.044) were independently associated with incomplete clinical success. The nomogram showed strong discriminative ability (C-index: 0.829) and good calibration. Internal validation confirmed its reliability (AUC: 0.844, sensitivity 84.2%, specificity 75.0%). CONCLUSION: This nomogram offers a reliable, easy-to-use tool for preoperative risk stratification of PA patients, facilitating personalized postoperative management. External validation in multicenter cohorts is warranted.