Adrenal venous sampling in primary aldosteronism: Experience of a Spanish multicentric study (Results from the SPAIN-ALDO Register)

Araujo‐Castro, Marta; Fano, Miguel Paja; Boillos, Marga González; Peris, Begoña Pla; Pascual‐Corrales, Eider; Cano, A.; Ramírez, Paola Parra; Rojas-Marcos, Patricia Martín; Ruiz-Sánchez, Jorge Gabriel; Delgado, Almudena Vicente; Hoyos, Emilia Gómez; Ferreira, Rui; Sanz, Íñigo García; Sala, Monica; Millán, Rebeca Barahona San; César, María José Picón; Guardiola, Patricia Díaz; González, Juan Jesús García; Perdomo, Carolina M; Miguélez, Laura Manjón; Centeno, Rogelio García; Percovich, Juan Carlos; Román, Ángel Rebollo; Gimeno, Paola Gracia; Lázaro, Cristina Robles; Morales-Ruíz, Manuel; Hanzu, Felicia A.

doi:10.1007/s12020-022-03122-8

Cited by 21 publications

(11 citation statements)

References 45 publications

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“…The current Endocrine Society guideline recommends performing AVS in all patients with PA so as to identify those who may benefit from surgery 2 . However, some recent research results have cast uncertainty on the role of AVS 15,21,22 . The SPARTACUS study found no difference in clinical outcomes between CT‐ and AVS‐based management 15 .…”

Section: Discussionmentioning

confidence: 99%

“…The SPARTACUS study found no difference in clinical outcomes between CT‐ and AVS‐based management 15 . Other studies also did not report significant differences in biochemical response and clinical resolution between patients who underwent surgery based on CT and AVS results 21,22 . Additionally, not all patients with unilateral adrenal aldosterone hypersecretion diagnosed by AVS can achieve complete biochemical remission after adrenalectomy 16,23 .…”

Section: Discussionmentioning

confidence: 99%

“…In the AVS study, only 77% of patients at 20 referral centers were systematically sent for AVS 25 . Additionally, the successful cannulation rates of both adrenal veins are widely variable in different studies, ranging from 20% to 99% 22,25,26 . CT might be reliable for PA patients with visible unilateral adenoma when AVS cannot be obtained for technical reasons.…”

Section: Discussionmentioning

confidence: 99%

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Surgery based on computed tomography images might be feasible for primary aldosteronism patients with visible unilateral adenoma

Fang,

Dai,

Zhao

et al. 2023

J of Clinical Hypertension

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Primary aldosteronism (PA) with unilateral adrenal disease can be cured or improved by adrenalectomy. Adrenal venous sampling (AVS) is recommended to identify patients for surgical management. However, surgeries based on computed tomography (CT) images are only advocated for PA patients aged <35 with visible unilateral adenoma. Herein, we aimed to compare CT‐based and AVS‐based surgery outcomes for PA patients with visible unilateral adenomas for different age groups. A total of 178 PA patients who underwent unilateral adrenalectomy between June 2018 and January 2021 were included in the study based on CT (n = 54) or AVS (n = 124). Demographics, diagnostics, and follow‐up data were retrospectively collected. Clinical and biochemical outcomes were analyzed according to Primary Aldosteronism Surgical Outcome (PASO) criteria at 1‐year follow‐up. Our results showed that complete clinical success (46.3% vs. 47.6%, p = 0.875) and complete biochemical success (88.8% vs. 91.9%, p = 0.515) were similar between the two groups. Age stratification revealed that patients >55 years old were likely to have worse biochemical outcomes; however, these were still not significantly different (21.4% vs. 8.6%, p = 0.220). Of the 114 AVS‐based patients who achieved complete biochemical success, 37 (32.4%) with bilateral normal or bilateral abnormal CT images changed treatment options according to AVS results, 1 (0.9%) avoided adrenalectomy on the wrong side. Our results indicated that surgery based on CT images might be feasible for highly selected PA patients with visible unilateral adenomas and less limited by age, while for those with normal adrenal or bilateral adrenal lesions, treatment strategy must be decided by AVS.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Surgery based on computed tomography images might be feasible for primary aldosteronism patients with visible unilateral adenoma

Fang,

Dai,

Zhao

et al. 2023

J of Clinical Hypertension

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“…At present, lateralization of aldosterone excess is determined by the lateralization index, which is calculated from the aldosterone-cortisol ratio of one adrenal vein compared with the other following the successful cannulation of both adrenal veins [18]. However, AVS is a technically demanding procedure, with reported bilateral cannulation success rates of 21-95.6% [13,[19][20][21][22]. Therefore, in the case of successful cannulation of just one adrenal vein, the lateralization index cannot be calculated and lateralization cannot be determined definitively.…”

Section: Introductionmentioning

confidence: 99%

Treatment decision based on unilateral index from nonadrenocorticotropic hormone-stimulated and adrenocorticotropic hormone-stimulated adrenal vein sampling in primary aldosteronism

Zhang,

Shu,

et al. 2023

Journal of Hypertension

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Objective: Adrenal venous sampling (AVS) is recommended for identifying the subtype of primary aldosteronism before making a surgical treatment decision, but failed cannulation of one adrenal vein is common. To evaluate whether using results of one adrenal vein during AVS could accurately predict unilateral primary aldosteronism. Methods: A retrospective study was conducted in primary aldosteronism patients receiving bilaterally or unilaterally successful AVS. The aldosterone–cortisol ratio from the adrenal vein divided by the aldosterone–cortisol ratio from the inferior vena cava (IVC) was calculated as the AV/IVC index. Results: The study examined 455 patients with primary aldosteronism, including 347 patients with unilateral primary aldosteronism. Among them, 250 and 125 patients received non- adrenocorticotropic hormone (ACTH) and ACTH-stimulated AVS, respectively, and 80 patients received both forms of AVS. Under non-ACTH-stimulated AVS, AUC of the AV/IVC index to diagnose ipsilateral and contralateral primary aldosteronism were 0.778 and 0.924, respectively. The specificity was 100% for both, with sensitivities of 5 and 26%, respectively, when using cutoffs of 17.05 to diagnose ipsilateral primary aldosteronism and 0.15 to diagnose contralateral primary aldosteronism. When using cutoffs of 3.60 and 0.70, the specificity decreased, but if combined with CT results (ipsilateral or contralateral adrenal nodules larger than 10 mm), the specificity could be maintained at 99%, with sensitivities of 33 and 45%, respectively. Under ACTH-stimulated AVS, the AV/IVC index showed similar accuracy to diagnose ipsilateral and contralateral primary aldosteronism. Conclusion: The unilateral AV/IVC index can be used to diagnose unilateral primary aldosteronism during AVS. Combining CT results can increase the accuracy further.

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“…There are more reasons why we question the current guidelines. First, complications in connection with AVS are rare and most often mild [15][16][17]. For instance, in a large international study with information from 2604 AVS conducted at 20 centers, the overall rate of adrenal vein rupture, a dreaded and serious complication, was only 0.6 % [17].…”

mentioning

confidence: 99%

Adrenal Vein Sampling in the Young – Necessary or Not?

Gkaniatsa¹,

Ragnarsson

2023

Exp Clin Endocrinol Diabetes

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Current clinical guidelines from the US Endocrine Society state that AVS may not be necessary in patients younger than 35 years who have marked aldosteronism and a solitary adrenal adenoma on imaging. At the time when the guidelines were published, only one study supported the statement, a study that included 6 patients younger than 35 years, all of whom who had unilateral adenoma on imaging and unilateral primary aldosteronism (PA) according to adrenal venous sampling (AVS). Since then, to our knowledge, four additional studies have been published that provide data on concordance between conventional imaging and AVS among patients younger than 35 years. In these studies, 7 of 66 patients with unilateral disease on imaging had bilateral disease according to AVS. We find it therefore reasonable to conclude that imaging studies alone inaccurately predict laterality in a significant number of young patients with PA, and that available data challenge the current clinical guidelines.

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Adrenal venous sampling in primary aldosteronism: Experience of a Spanish multicentric study (Results from the SPAIN-ALDO Register)

Cited by 21 publications

References 45 publications

Surgery based on computed tomography images might be feasible for primary aldosteronism patients with visible unilateral adenoma

Surgery based on computed tomography images might be feasible for primary aldosteronism patients with visible unilateral adenoma

Treatment decision based on unilateral index from nonadrenocorticotropic hormone-stimulated and adrenocorticotropic hormone-stimulated adrenal vein sampling in primary aldosteronism

Adrenal Vein Sampling in the Young – Necessary or Not?

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