Does Contralateral Suppression at Adrenal Venous Sampling Predict Outcome Following Unilateral Adrenalectomy for Primary Aldosteronism? A Retrospective Study

Wolley, Martin; Gordon, Richard D.; Ahmed, Ashraf; Stowasser, Michael

doi:10.1210/jc.2014-3676

Cited by 85 publications

(92 citation statements)

References 22 publications

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“…3,4 Confirmatory testing and synacthen test were performed as detailed elsewhere. [13][14][15] All patients included in the analysis gave written informed consent, and approval from the local ethics committees was obtained for the use of these retrospective data. The study adheres to the principles of the Declaration of Helsinki and to institutional guidelines.…”

Section: Patient Selectionmentioning

confidence: 99%

“…In particular, interfering medications were withdrawn at least 4 weeks prior to testing and the aldosterone to renin ratio (ARR) was used as a screening test. The diagnosis of PA was confirmed using fludrocortisone suppression testing, the intra-venous saline loading test or the captopril challenge test, as detailed elsewhere (13,14). All patients with a confirmed diagnosis of PA underwent adrenal CT scanning or MRI and AVS for subtype differentiation.…”

Section: Novelty and Significancementioning

confidence: 99%

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Clinical Management and Outcomes of Adrenal Hemorrhage Following Adrenal Vein Sampling in Primary Aldosteronism

et al. 2016

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Aldosterone-producing adenoma and bilateral adrenal hyperplasia account for >90% of all primary aldosteronism cases. Distinguishing between bilateral and unilateral disease is of fundamental importance because it allows targeted therapy. Adrenal vein sampling (AVS) is the only reliable means to preoperatively differentiate between unilateral and bilateral subtypes. A rare but serious complication of AVS is an adrenal hemorrhage (AH). We retrospectively examined in detail 24 cases of AH during AVS in 6 different referral hypertension centers. AH more often affected the right adrenal (n=18) than the left (n=5, P <0.001); 1 bilateral. Median duration of experience of the radiologist in AVS at the time of AH was 5.0 years (0.6–7.8) and AH occurred with both highly experienced (>10 years) and less experienced radiologists. Of 9 patients who suffered AH in the gland contralateral to an aldosterone-producing adenoma and who underwent complete (n=6) or partial (n=3) unilateral adrenalectomy, only one required long-term corticosteroid replacement for adrenal insufficiency. No reduction in blood pressure or biochemical resolution of primary aldosteronism occurred in any of those patients who experienced AH in the gland ipsilateral to an aldosterone-producing adenoma (n=6) or who had bilateral adrenal hyperplasia (n=9). No patient required invasive treatments to control bleeding or blood transfusion. In conclusion, AH usually has a positive outcome causing either no or minor effects on adrenal function, and AVS should remain the best approach to primary aldosteronism subtype differentiation.

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Section: Patient Selectionmentioning

confidence: 99%

Section: Novelty and Significancementioning

confidence: 99%

Clinical Management and Outcomes of Adrenal Hemorrhage Following Adrenal Vein Sampling in Primary Aldosteronism

et al. 2016

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“…In addition, AVS protocols vary among centers in the following aspects: the procedure of sampling (simultaneous or sequential bilateral sampling), the mode of stimulation (unstimulated, continuous or bolus infusion of cosyntropin), and the adoption of selectivity index (SI) and lateralization index (LI) (5, 6, 7), thus, cross comparison of the results can prove challenging. Some investigators have reported that the 'contralateral suppression index (CSI)' could be another key finding to identify the lesions responsible for excess secretion of aldosterone (6,8,9,10). In APA patients with mild-to-moderate secretion of excess aldosterone, especially in those with computed tomography (CT)-undetectable aldosteroneproducing micro-adenoma (micro-APA), some centers have reported to detect laterality of hyperaldosteronism using their own protocols (11,12).…”

Section: Introductionmentioning

confidence: 99%

Is there a role for segmental adrenal venous sampling and adrenal sparing surgery in patients with primary aldosteronism?

Satoh¹,

Morimoto²,

Seiji³

et al. 2015

European Journal of Endocrinology

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Objective and design: Adrenal venous sampling (AVS) is critical to determine the subtype of primary aldosteronism (PA). Central AVS (C-AVS) -that is, the collection of effluents from bilateral adrenal central veins (CV) -sometimes does not allow differentiation between bilateral aldosterone-producing adenomas (APA) and idiopathic hyperaldosteronism. To establish the best treatment course, we have developed segmental AVS (S-AVS); that is, we collect effluents from the tributaries of CV to determine the intra-adrenal sources of aldosterone overproduction. We then evaluated the clinical utility of this novel approach in the diagnosis and treatment of PA. Methods: We performed C-AVS and/or S-AVS in 297 PA patients and assessed the accuracy of diagnosis based on the results of C-AVS (nZ138, 46.5%) and S-AVS (nZ159, 53.5%) by comparison with those of clinicopathological evaluation of resected specimens.Results: S-AVS demonstrated both elevated and attenuated secretion of aldosterone from APA and non-tumorous segments, respectively, in patients with bilateral APA and recurrent APA. These findings were completely confirmed by detailed histopathological examination after surgery. S-AVS, but not C-AVS, also served to identify APA located distal from the CV. Conclusions: Compared to C-AVS, S-AVS served to identify APA in some patients, and its use should expand the pool of patients eligible for adrenal sparing surgery through the identification of unaffected segments, despite the fact that S-AVS requires more expertise and time. Especially, this new technique could enormously benefit patients with bilateral or recurrent APA because of the preservation of non-tumorous glandular tissue.

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“…To directly compare the performance of eight other steroids from the adrenal gland to cortisol, we applied the previously validated criteria for catheter positioning and lateralization [7]. The contralateral suppression of aldosterone secretion, defined as lower normalized aldosterone in a nondominant adrenal gland than that of a peripheral sample, was suggested to be a predictor for biochemical resolution of PA and improvement in blood pressure [22]. Thus, it has been used as additional criteria for identifying patients with unilateral disease when cosyntropin is not given [23].…”

Section: Discussionmentioning

confidence: 99%

11‐Deoxycortisol may be Superior to Cortisol in Confirming a Successful Adrenal Vein Catheterization without Cosyntropin: A Pilot Study

Nilubol

Soldin

Patel

et al. 2017

Int. J. Endo. Oncol.

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aim:We aimed to compare the performance of nine adrenal steroids in confirming the correct catheter position during adrenal venous sampling (AVS) without cosyntropin in patients with primary hyperaldosteronism. materials & methods: A successful adrenal vein catheterization without cosyntropin was defined as the ratio of steroids from adrenal to peripheral veins being >3:1. AVS samples from four patients with primary hyperaldosteronism were analyzed. results: Compared with the mean ratio of cortisol without cosyntropin, the ratios of 11-deoxycortisol (p = 0.008), dehydroepiandrosterone (p = 0.01) and androstenedione (p = 0.008) were significantly higher. None of the ratios (n = 8) of cortisol from adrenal to peripheral veins exceeded 3:1, while all ratios of 11-deoxycortisol (p < 0.001) were >3. Conclusion: Cosyntropin infusion during AVS may not be necessary if 11-deoxycortisol is used to confirm catheter position. • Because imaging alone cannot reliably distinguish aldosterone-producing adenoma from commonly detected nonfunctioning adrenal nodules. Adrenal venous sampling is considered the gold standard for selecting patients who would benefit from an adrenalectomy.• There are two areas that need to be assessed from adrenal venous sampling: the position of the catheter when the samples are collected and a comparison of normalized aldosterone production from each adrenal gland.• To confirm a successful adrenal vein catheterization, a commonly used criterion is the ratio of cortisol from the adrenal vein to the peripheral vein greater than 3:1 without cosyntropin infusion.• Compared with the cosyntropin-stimulated cortisol ratio of adrenal to peripheral veins, the nonstimulated ratio can be falsely low, suggesting incorrect catheter placement occurred in approximately 50% of the samples.• Our pilot study suggests that 11-deoxycortisol is more accurate in identifying correct position of the catheter than cortisol without cosyntropin infusion. Thus, it can simplify the procedure and reduce false-negative results associated with cosyntropin infusion.For reprint orders, please contact: reprints@futuremedicine.com

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Does Contralateral Suppression at Adrenal Venous Sampling Predict Outcome Following Unilateral Adrenalectomy for Primary Aldosteronism? A Retrospective Study

Abstract: In this study, the presence of CS correlated with good BP and biochemical outcomes from surgery. This finding suggests that CS should be a factor in deciding whether to offer surgery for treatment of PA.

Cited by 85 publications

References 22 publications

Clinical Management and Outcomes of Adrenal Hemorrhage Following Adrenal Vein Sampling in Primary Aldosteronism

Clinical Management and Outcomes of Adrenal Hemorrhage Following Adrenal Vein Sampling in Primary Aldosteronism

Is there a role for segmental adrenal venous sampling and adrenal sparing surgery in patients with primary aldosteronism?

11‐Deoxycortisol may be Superior to Cortisol in Confirming a Successful Adrenal Vein Catheterization without Cosyntropin: A Pilot Study

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