Adrenal Venous Sampling for Subtype Diagnosis of Primary Hyperaldosteronism

Naruse, Mitsuhide; Tanabe, Akiyo; Yamamoto, Kōichi; Rakugi, Hiromi; Kometani, Mitsuhiro; Yoneda, Takashi; Kobayashi, Hiroki; Abe, Masanori; Ohno, Youichi; Inagaki, Nobuya; Izawa, Shoichiro; Sone, Masakatsu

doi:10.3803/enm.2021.1192

Cited by 11 publications

(4 citation statements)

References 63 publications

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“…Adrenal veins received the blood from the adrenal gland, the serum of which could reflect adrenal local lesions. AVS results have demonstrated aldosterone level in the dominant side is significantly elevating than that in non-dominant side in UPA patients 38 . In order to further study the difference of the dominant and non-dominant sides in adrenal gland, we collected the plasma from bilateral adrenal veins and the blood from inferior vena cava served as control group.…”

Section: Discussionmentioning

confidence: 94%

Diagnostic accuracy of using multiple cytokines to predict aldosterone-producing adenoma

Qin

Wen

Zhong

et al. 2023

Sci Rep

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Here, we aimed to study the important cytokines in plasma to identify the aldosterone-producing adenoma (APA). 19 unilateral primary aldosteronism (UPA) patients and 19 healthy people were divided into UPA group and Control group, and the serum of bilateral adrenal veins and inferior vena cava collected by adrenal blood sampling (AVS) in UPA patients and the serum from the healthy subjects were all used to detect multiple cytokines by Luminex immunoassays. Additionally, The UPA patients subjected to laparoscopic adrenalectomy were divided into different groups by pathological results for further study. According our results, IP-10, CXCL9 and RANTES were significantly higher in UPA group compared with control group, and the combination of the three cytokines have significant predictive power for predicting UPA, while the correlational analyses demonstrated that IP-10 and CXCL9 were positively correlated with BP and HR, while EGF was positively correlated with HDL. Additionally, IL-1b was suggested to be the most potential diagnostic biomarker to discriminate the APA and unilateral adrenal hyperplasia (UAH). The present findings might suggest a possibility of IP-10, CXCL9 and RANTES served as a sign to help UPA diagnosis and finally used to assist the diagnosis of APA, while IL-1b was suggested to be the most potential diagnostic biomarker to identify the APA from the UAH patients.

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Section: Discussionmentioning

confidence: 94%

Diagnostic accuracy of using multiple cytokines to predict aldosterone-producing adenoma

Qin

Wen

Zhong

et al. 2023

Sci Rep

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“…AVS is a diagnostic procedure performed to differentiate between unilateral and bilateral adrenal disease, particularly in PA [ 79 ]. Due to limitations of various imaging techniques in accurately differentiating these subtypes, AVS has remained the gold standard diagnostic tool [ 80 ].…”

Section: Subtypingmentioning

confidence: 99%

2023 Korean Endocrine Society Consensus Guidelines for the Diagnosis and Management of Primary Aldosteronism

Ha,

Park,

Kim

et al. 2023

Endocrinol Metab

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Primary aldosteronism (PA) is a common, yet underdiagnosed cause of secondary hypertension. It is characterized by an overproduction of aldosterone, leading to hypertension and/or hypokalemia. Despite affecting between 5.9% and 34% of patients with hypertension, PA is frequently missed due to a lack of clinical awareness and systematic screening, which can result in significant cardiovascular complications. To address this, medical societies have developed clinical practice guidelines to improve the management of hypertension and PA. The Korean Endocrine Society, drawing on a wealth of research, has formulated new guidelines for PA. A task force has been established to prepare PA guidelines, which encompass epidemiology, pathophysiology, clinical presentation, diagnosis, treatment, and follow-up care. The Korean clinical guidelines for PA aim to deliver an evidence-based protocol for PA diagnosis, treatment, and patient monitoring. These guidelines are anticipated to ease the burden of this potentially curable condition.

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“…AVS is required in bilateral PA (including the ACS subgroup), and aldosterone as well as cortisol should be assessed; the procedure is not automatically available in many centres, and sometimes the results are inconclusive or display a high variability in PA, despite an experienced team [ 95 , 96 , 97 , 98 , 99 , 100 , 101 , 102 , 103 ]. However, AVS brings supplementary information to imaging procedures allowing better surgical decisions, with a success rate of 76–90%, and the presence of concomitant cortisol excess is mandatory for assessment [ 95 , 96 , 97 , 98 , 99 , 100 , 101 , 104 , 105 ].…”

Section: Approach Of Connshing Syndromementioning

confidence: 99%

The Entity of Connshing Syndrome: Primary Aldosteronism with Autonomous Cortisol Secretion

Cârșote¹

2022

Diagnostics

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Connshing syndrome (CoSh) (adrenal-related synchronous aldosterone (A) and cortisol (C) excess) represents a distinct entity among PA (primary hyperaldosteronisms) named by W. Arlt et al. in 2017, but the condition has been studied for more than 4 decades. Within the last few years, this is one of the most dynamic topics in hormonally active adrenal lesions due to massive advances in steroids metabolomics, molecular genetics from CYP11B1/B2 immunostaining to genes constellations, as well as newly designated pathological categories according to the 2022 WHO classification. In gross, PA causes 4–10% of all high blood pressure (HBP) cases, and 20% of resistant HBP; subclinical Cushing syndrome (SCS) is identified in one-third of adrenal incidentalomas (AI), while CoSh accounts for 20–30% to 77% of PA subjects, depending on the tests used to confirm autonomous C secretion (ACS). The clinical picture overlaps with PA, hypercortisolemia being mild. ACS is suspected in PA if a more severe glucose and cardiovascular profile is identified, or there are larger tumours, ACS being an independent factor risk for kidney damage, and probably also for depression/anxiety and osteoporotic fractures. It seems that one-third of the PA-ACS group harbours mutations of C-related lines like PRKACA and GNAS. A novel approach means we should perform CYP11B2/CYP11B1 immunostaining; sometimes negative aldosteronoma for CYP11B1 is surrounded by micronodules or cell clusters with positive CYP11B1 to sustain the C excess. Pitfalls of hormonal assessments in CoSh include the index of suspicion (check for ACS in PA patients) and the interpretation of A/C ratio during adrenal venous sample. Laparoscopic adrenalectomy is the treatment of choice. Post-operative clinical remission rate is lower in CoSh than PA. The risk of clinically manifested adrenal insufficiency is low, but a synthetic ACTH stimulating testing might help to avoid unnecessary exposure to glucocorticoids therapy. Finally, postponing the choice of surgery may impair the outcome, having noted that long-term therapy with mineralocorticoids receptors antagonists might not act against excessive amounts of C. Awareness of CoSh improves management and overall prognosis.

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Adrenal Venous Sampling for Subtype Diagnosis of Primary Hyperaldosteronism

Cited by 11 publications

References 63 publications

Diagnostic accuracy of using multiple cytokines to predict aldosterone-producing adenoma

Diagnostic accuracy of using multiple cytokines to predict aldosterone-producing adenoma

2023 Korean Endocrine Society Consensus Guidelines for the Diagnosis and Management of Primary Aldosteronism

The Entity of Connshing Syndrome: Primary Aldosteronism with Autonomous Cortisol Secretion

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