Diagnostic utility of data from adrenal venous sampling for primary aldosteronism despite failed cannulation of the right adrenal vein

Pasternak, Jesse D.; Epelboym, Irene; Seiser, Natalie; Wingo, Matthew; Herman, Max Charles; Cowan, Vanessa; Gosnell, Jessica E.; Shen, Wen T.; Kerlan, Robert K.; Lee, James A.; Duh, Quan‐Yang; Suh, Insoo

doi:10.1016/j.surg.2015.06.048

Cited by 49 publications

(71 citation statements)

References 20 publications

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“…The postoperative clinical course was defined as follows: (i) cured, blood pressure <140/90 mmHg without any medication and normalization of serum potassium, (ii) improvement, blood pressure <140/90 mmHg on reduced medication or normalization of serum potassium and (iii) no improvement, persistence of hypertension with the same or increased medication and hypokalaemia. On the other hand, three of 19 patients with AVS failure were classified as having BHA because of the supporting data, including bilateral uptake of 131 I‐adosterol, no contralateral aldosterone suppression, no extremely high aldosterone levels and no adrenal nodules on CT imaging . Finally, we diagnosed 37 patients with UHA and 36 with BHA.…”

Section: Methodsmentioning

confidence: 90%

“…Based on the AVS results of 82 patients with PA, 29 were diagnosed with UHA and 33 with BHA. Although the cannulation of the right‐side adrenal vein during AVS was unsuccessful in 20 patients, eight were diagnosed with UHA because of supporting information, including contralateral ratio (CR) <1, extremely high aldosterone levels at the tumour site and unilateral uptake of 131 I‐adosterol . All eight patients underwent surgery and were confirmed to have UHA because of the postoperative clinical course (wherein four were cured and four showed improvement).…”

Section: Methodsmentioning

confidence: 99%

“…Although the cannulation of the right-side adrenal vein during AVS was unsuccessful in 20 patients, eight were diagnosed with UHA because of supporting information, including contralateral ratio (CR) <1, extremely high aldosterone levels at the tumour site and unilateral uptake of 131 I-adosterol. 16,17 All eight patients underwent surgery and were confirmed to have UHA because of the postoperative clinical course (wherein four were cured and four showed improvement). The postoperative clinical course was defined as follows: (i) cured, blood pressure <140/90 mmHg without any medication and normalization of serum potassium, (ii) improvement, blood pressure <140/ 90 mmHg on reduced medication or normalization of serum potassium and (iii) no improvement, persistence of hypertension with the same or increased medication and hypokalaemia.…”

Section: Adrenal Venous Samplingmentioning

confidence: 99%

“…On the other hand, three of 19 patients with AVS failure were classified as having BHA because of the supporting data, including bilateral uptake of 131 I-adosterol, no contralateral aldosterone suppression, no extremely high aldosterone levels and no adrenal nodules on CT imaging. 16,17 Finally, we diagnosed 37 patients with UHA and 36 with BHA. Among the 37 patients with UHA, 32 underwent adrenalectomy and were cured or showed improvement.…”

Section: Adrenal Venous Samplingmentioning

confidence: 99%

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Scoring system for the diagnosis of bilateral primary aldosteronism in the outpatient setting before adrenal venous sampling

Kobayashi

Haketa

Ueno

et al. 2016

Clinical Endocrinology

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Section: Methodsmentioning

confidence: 90%

Section: Methodsmentioning

confidence: 99%

Section: Adrenal Venous Samplingmentioning

confidence: 99%

Section: Adrenal Venous Samplingmentioning

confidence: 99%

See 2 more Smart Citations

Scoring system for the diagnosis of bilateral primary aldosteronism in the outpatient setting before adrenal venous sampling

Kobayashi

Haketa

Ueno

et al. 2016

Clinical Endocrinology

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“…Contralateral suppression is also useful in situations where only one adrenal vein has been successfully cannulated, because it can predict unilateral disease on the other side. One recent study examined the predictive value of only left adrenal vein sampling results compared with the diagnosis achieved from bilateral sampling, using a source and then validation cohort [ 67 ]. Using a left adrenal vein indicated a peripheral aldosterone/cortisol ratio of 0.5 or lower to indicate right unilateral primary aldosteronism and of at least 5.5 to indicate a left source had a positive predictive value of 100%.…”

Section: Case Detection and Screening For Primary Aldosteronismmentioning

confidence: 99%

New Advances in the Diagnostic Workup of Primary Aldosteronism

Wolley

Stowasser

2017

Journal of the Endocrine Society

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Primary aldosteronism is an important and common cause of hypertension that carries a high burden of morbidity. Outcomes, however, are excellent if diagnosed and treated appropriately. The diagnostic workup for primary aldosteronism is complex and comprises three steps: (1) screening, (2) confirmatory testing, and (3) subtype differentiation. In this review, we discuss recent advances in the diagnostic workup for primary aldosteronism. The development of accurate mass spectroscopy–based assays for measuring aldosterone will lead to improved confidence in all diagnostic aspects involving measurement of aldosterone, and accurate measurement of angiotensin II may soon advance us beyond the measurement of renin. We now have a greater understanding of hormonal influences on the aldosterone/renin ratio, which are particularly important when screening premenopausal women or those taking estrogen-containing preparations. Confirmatory testing is important, but there are limitations to the commonly used methods that have recently become more apparent, with new approaches offering a way forward. Adrenal venous sampling (AVS) is a challenging procedure but is important for deciding on treatment options. Success rates may be improved by the use of Synacthen stimulation and of rapid intraprocedural measurement of cortisol. Better understanding of AVS interpretation criteria allows improved prognostication and aids treatment decisions. The use of labeled metomidate positron emission tomography computed tomography scanning may also offer an alternative to AVS in some units. Although the diagnostic approach to patients with primary aldosteronism remains a complex multistep process in which attention to detail is important, recent advances will improve patient care and outcomes.

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Corticotropin Stimulation in Adrenal Venous Sampling for Patients With Primary Aldosteronism

Yang,

Du,

Zhang

et al. 2023

JAMA Netw Open

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ImportanceAdrenal venous sampling (AVS) is usually recommended to distinguish between unilateral and bilateral primary aldosteronism (PA) before definitive surgical or medical treatment is offered. Whether a treatment decision based on AVS with or without corticotropin (ACTH) stimulation leads to different biochemical and clinical remission rates in patients with PA remains unclear.ObjectiveTo evaluate whether treatment decisions based on AVS with or without ACTH stimulation lead to different biochemical and clinical remission rates in patients with PA.Design, Setting, and ParticipantsThis randomized clinical trial (RCT) was conducted at a tertiary hospital in China from July 8, 2020, to February 20, 2023, among patients with PA aged 18 to 70 years. Patients were followed up for 12 months after the initiation of treatment. An intention-to-diagnose analysis was conducted.InterventionsPatients were randomly assigned to undergo either ACTH-stimulated or non–ACTH-stimulated AVS.Main Outcomes and MeasuresThe primary end point was the proportion of patients with complete biochemical remission after 12 months of follow-up. Secondary outcomes included the proportion of patients who achieved complete clinical remission after 12 months of follow-up, dosages of antihypertensive agents, rate of successful bilateral AVS, and adverse events.ResultsOf 228 patients with PA, 115 were randomized to the non–ACTH-stimulated group (median age, 50.0 years [IQR, 41.0-57.0 years]; 70 males [60.9%]) and 113 to the ACTH-stimulated group (median age, 50.0 years [IQR, 43.5-56.5 years]; 63 males [55.8%]). A total of 68 patients (59.1%) underwent adrenalectomy in the non-ACTH group and 65 (57.5%) in the ACTH group. There was no significant difference in the proportion of patients with complete biochemical remission who were managed on the basis of AVS with vs without ACTH stimulation (with: 56 of 113 [49.6%]; without: 59 of 115 [51.3%]; P = .79). There also was no significant difference in the proportion of patients who achieved complete clinical remission between the non-ACTH and ACTH groups (26 of 115 [22.6%] and 31 of 113 [27.4%], respectively; P = .40). The intensity of therapy with antihypertensives, successful catheterization of bilateral adrenal veins, and incidence of adverse events did not significantly differ between the non-ACTH and ACTH groups.Conclusions and RelevanceIn this RCT, treatment of PA on the basis of non–ACTH-stimulated or ACTH-stimulated AVS did not lead to significant differences in clinical outcomes for the patients. These results suggest that ACTH stimulation during AVS may not have clinical benefit, at least in the Chinese population.Trial RegistrationClinicalTrials.gov Identifier: NCT04461535

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Diagnostic utility of data from adrenal venous sampling for primary aldosteronism despite failed cannulation of the right adrenal vein

Cited by 49 publications

References 20 publications

Scoring system for the diagnosis of bilateral primary aldosteronism in the outpatient setting before adrenal venous sampling

Scoring system for the diagnosis of bilateral primary aldosteronism in the outpatient setting before adrenal venous sampling

New Advances in the Diagnostic Workup of Primary Aldosteronism

Corticotropin Stimulation in Adrenal Venous Sampling for Patients With Primary Aldosteronism

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