Computed Tomography and Adrenal Venous Sampling in the Diagnosis of Unilateral Primary Aldosteronism

Williams, Tracy Ann; Burrello, Jacopo; Sechi, Leonardo Antonio; Fardella, Carlos E.; Matrozova, Joanna; Adolf, Christian; Baudrand, René; Bernardi, Stella; Beuschlein, Felix; Catena, Cristiana; Doumas, Michalis; Fallo, Francesco; Giacchetti, Gilberta; Heinrich, Daniel A.; Saint‐Hilary, Gaëlle; Jansen, Pieter; Januszewicz, Andrzej; Kocjan, Tomaž; Nishikawa, Tetsuo; Quinkler, Marcus; Satoh, Fumitoshi; Umakoshi, Hironobu; Widimský, Jiří; Hahner, Stefanie; Δούμα, Στέλλα; Stowasser, Michael; Mulatero, Paolo; Reincke, Martín

doi:10.1161/hypertensionaha.118.11382

Cited by 104 publications

(109 citation statements)

References 32 publications

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“…In their prospective study, CT localization of APAs demonstrated equivalent sensitivity and specificity to AVS. However, study participants had visible adrenal lesions >7 mm and a large proportion had hypokalaemia (or “low normal” serum potassium) at the time of presentation . When applied to the broader characteristics of patients diagnosed with PA, the sensitivity of CT remains low when adhering to criteria based on the patient characteristics within the SPARTACUS study.…”

Section: Discussionmentioning

confidence: 99%

¹¹C‐Metomidate PET/CT is a useful adjunct for lateralization of primary aldosteronism in routine clinical practice

O’Shea

O'Donoghue

Bashari

et al. 2019

Clinical Endocrinology

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Summary Objective To describe clinical practice experience of 11C‐Metomidate PET/CT as an adjunct to adrenal vein sampling (AVS) in the lateralization of aldosterone‐producing adenomas (APA) in primary aldosteronism (PA). Context Accurate lateralization of APA in the setting of PA offers the potential for surgical cure and improved long‐term cardiovascular outcomes. Challenges associated with AVS, the current gold standard lateralization modality, mean that only a small proportion of potentially eligible patients currently make it through to surgery. This has prompted consideration of alternative strategies for lateralization, including the application of novel molecular PET tracers such as 11C‐Metomidate. Design Clinical Service Evaluation/Retrospective audit. Patients Fifteen individuals with a confirmed diagnosis of PA, undergoing lateralization with 11C‐Metomidate PET/CT prior to final clinical decision on surgical vs medical management. Measurements All patients underwent screening aldosterone renin ratio (ARR), followed by confirmatory testing with the seated saline infusion test, according to Endocrine Society Clinical Practice Guidelines. Adrenal glands were imaged using dedicated adrenal CT. 11C‐Metomidate PET/CT was undertaken due to equivocal or failed AVS. Management outcomes were assessed by longitudinal measurement of blood pressure, ARR, number of hypertensive medications following adrenalectomy or institution of medical therapy. Results We describe the individual lateralization and clinical outcomes for 15 patients with PA. Conclusion 11C‐Metomidate PET/CT in conjunction with adrenal CT and AVS provided useful information which aided clinical decision‐making for PA within a multidisciplinary hypertension clinic.

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Section: Discussionmentioning

confidence: 99%

¹¹C‐Metomidate PET/CT is a useful adjunct for lateralization of primary aldosteronism in routine clinical practice

O’Shea

O'Donoghue

Bashari

et al. 2019

Clinical Endocrinology

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“…The differentiation of unilateral from bilateral forms is achieved by computed tomography (CT) or adrenal venous sampling (AVS). AVS is the recommended approach by the Endocrine Society Guideline 11 because of the lack of specificity and sensitivity of CT [12][13] . The objective of adrenalectomy is to resolve excessive aldosterone production, normalize plasma potassium concentrations (if the patient was hypokalemic pre-surgically), and to normalize or at least improve the elevated blood pressure which is characteristic of the disorder.…”

Section: Introductionmentioning

confidence: 99%

The Primary Aldosteronism Surgical Outcome Score for the Prediction of Clinical Outcomes After Adrenalectomy for Unilateral Primary Aldosteronism

Burrello

Stowasser

et al. 2019

Annals of Surgery

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Objective: To develop a prediction model for clinical outcomes after unilateral adrenalectomy for unilateral primary aldosteronism. Summary Background Data: Unilateral primary aldosteronism is the most common surgically curable form of endocrine hypertension. Surgical resection of the dominant overactive adrenal in unilateral primary aldosteronism results in complete clinical success with resolution of hypertension without antihypertensive medication in less than half of patients with a wide between-center variability. Methods: A linear discriminant analysis (LDA) model was built using data of 380 patients treated by adrenalectomy for unilateral primary aldosteronism to classify post-surgical clinical outcomes. The total cohort was then randomly divided into training (280 patients) and test (100 patients) datasets to create and validate a score system to predict clinical outcomes. An online tool (PASO [Primary Aldosteronism Surgical Outcome] predictor) was developed to facilitate the use of the predictive score. Results: Six presurgical factors associated with complete clinical success (known duration of hypertension, sex, antihypertensive medication dosage, body mass index, target organ damage and size of largest nodule at imaging) were selected based on classification performance in the LDA model. A 25-point predictive score was built with an optimal cutoff of greater than 16 points (accuracy of prediction = 79.2%; specificity = 84.4%; sensitivity = 71.3%) with an area under the curve of 0.839. Conclusions: The predictive score and the PASO predictor can be used in a clinical setting to differentiate patients who are likely to be clinically cured after surgery from those who will need continuous surveillance after surgery due to persistent hypertension.

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“…AVS is a gold standard test to confirm the subtype classification of PA. In fact, a recent study reported that patients diagnosed by CT have a decreased likelihood of achieving complete biochemical success compared with a diagnosis by AVS . Therefore, AVS should basically be performed in most patients with PA who undergo adrenalectomy, if indicated.…”

Section: Discussionmentioning

confidence: 99%

A case of primary aldosteronism with resistant hypertension successfully treated by unilateral adrenalectomy after unsuccessful classification of subtype in adrenal venous sampling

Nakamaru

Yamamoto

Nozato

et al. 2019

Clinical Case Reports

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Computed Tomography and Adrenal Venous Sampling in the Diagnosis of Unilateral Primary Aldosteronism

Abstract: Abstract-Unilateral primary aldosteronism is the most common surgically correctable form of endocrine hypertension and is usually differentiated from bilateral forms by adrenal venous sampling (AVS) or computed tomography (CT

Cited by 104 publications

References 32 publications

¹¹C‐Metomidate PET/CT is a useful adjunct for lateralization of primary aldosteronism in routine clinical practice

¹¹C‐Metomidate PET/CT is a useful adjunct for lateralization of primary aldosteronism in routine clinical practice

The Primary Aldosteronism Surgical Outcome Score for the Prediction of Clinical Outcomes After Adrenalectomy for Unilateral Primary Aldosteronism

A case of primary aldosteronism with resistant hypertension successfully treated by unilateral adrenalectomy after unsuccessful classification of subtype in adrenal venous sampling

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Computed Tomography and Adrenal Venous Sampling in the Diagnosis of Unilateral Primary Aldosteronism

Abstract: Abstract-Unilateral primary aldosteronism is the most common surgically correctable form of endocrine hypertension and is usually differentiated from bilateral forms by adrenal venous sampling (AVS) or computed tomography (CT

Cited by 104 publications

References 32 publications

11C‐Metomidate PET/CT is a useful adjunct for lateralization of primary aldosteronism in routine clinical practice

11C‐Metomidate PET/CT is a useful adjunct for lateralization of primary aldosteronism in routine clinical practice

The Primary Aldosteronism Surgical Outcome Score for the Prediction of Clinical Outcomes After Adrenalectomy for Unilateral Primary Aldosteronism

A case of primary aldosteronism with resistant hypertension successfully treated by unilateral adrenalectomy after unsuccessful classification of subtype in adrenal venous sampling

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¹¹C‐Metomidate PET/CT is a useful adjunct for lateralization of primary aldosteronism in routine clinical practice

¹¹C‐Metomidate PET/CT is a useful adjunct for lateralization of primary aldosteronism in routine clinical practice