scholarly journals Steroidogenic Activity in Unresected Adrenals Associated With Surgical Outcomes in Primary Aldosteronism

Hypertension ◽  
2021 ◽  
Vol 77 (5) ◽  
pp. 1638-1646
Author(s):  
Kazuki Nakai ◽  
Yuya Tsurutani ◽  
Kosuke Inoue ◽  
Seishi Matsui ◽  
Kohzoh Makita ◽  
...  
Keyword(s):  
Adrenal Gland ◽  
Primary Aldosteronism ◽  
Surgical Outcomes ◽  
Area Under The Curve ◽  
Adrenal Venous Sampling ◽  
Central Vein ◽  
Venous Sampling ◽  
Unilateral Adrenalectomy ◽  
Complete Group ◽  
Success Group

In patients with primary aldosteronism diagnosed with unilateral lesions through adrenal venous sampling, excess aldosterone occasionally persists after adrenalectomy. We investigated whether aldosterone values from unresected adrenals would be associated with postoperative outcomes. Overall, 102 primary aldosteronism patients, who underwent segmental adrenal venous sampling and unilateral adrenalectomy, were assessed for biochemical success (as outlined in the PASO [Primary Aldosteronism Surgical Outcomes] Study) at 1 year after surgery by using the saline infusion test. We divided patients into the biochemical complete or incomplete success group. Eighty-seven and 15 patients had complete and incomplete biochemical success, respectively. The biochemical incomplete group, compared with the biochemical complete group, had higher maximum aldosterone in tributary veins (11 000 versus 7030 pg/mL, P =0.006), maximum aldosterone/cortisol in tributary veins (18.05 versus 9.13, P <0.001), aldosterone in the central vein (9260 versus 5800 pg/mL, P =0.011), and aldosterone/cortisol in the central vein (13.67 versus 8.08, P <0.001) of the unresected adrenal gland. In logistic regression analyses, maximum aldosterone/cortisol in tributary veins had the highest area under the curve (0.780). Aldosterone/cortisol in the central vein had a nearly equivalent area under the curve (0.775). The lateralization index showed no significant differences between the groups. The clinical incomplete group similarly had higher aldosterone and aldosterone/cortisol in the unresected adrenal gland than did the clinical complete group. Therefore, steroidogenic activity in unresected adrenals (eg, absolute aldosterone value and aldosterone/cortisol) were associated with surgical outcomes. Our results may aid clinicians in determining the surgical application for primary aldosteronism.

scholarly journals Utility of microcatheter in adrenal venous sampling for primary aldosteronism

2020 ◽  
Vol 93 (1109) ◽  
pp. 20190636
Author(s):  
Yoshifumi Noda ◽  
Satoshi Goshima ◽  
Shoma Nagata ◽  
Hiroshi Kawada ◽  
Yukichi Tanahashi ◽  
...  
Keyword(s):  
Primary Aldosteronism ◽  
Correct Diagnosis ◽  
Plasma Aldosterone ◽  
University Hospital ◽  
Adrenal Venous Sampling ◽  
Common Trunk ◽  
Central Vein ◽  
Venous Sampling ◽  
Institutional Review ◽  
The Right

Objective: To evaluate the utility of microcatheter in adrenal venous sampling (AVS) for assessing aldosterone hypersecretion and the laterality in patients with primary aldosteronism. Methods: This retrospective study was approved by the institutional review board of Gifu University Hospital, and written informed consent was waived. A total of 37 consecutive patients with primary aldosteronism underwent AVS by inserting a microcatheter into the right adrenal central vein (RCV), left adrenal central vein (LCV), and left adrenal common trunk (CT) followed by AVS with 5-French (5-Fr) catheter. The diagnosis of aldosterone hypersecretion was confirmed if the plasma aldosterone level after the administration of cosyntropin injection was ≥14,000 pg/ml. The laterality of aldosterone hypersecretion was determined based on the lateralized and contralateral ratios. Aldosterone hypersecretion and the laterality were diagnosed and compared based on the results obtained using 5-Fr catheter and microcatheter. Results: Plasma aldosterone levels were significantly higher in the RCV, LCV, and CT selected using microcatheter than in the right and left adrenal veins (LAVs) selected using 5-Fr catheter (p < 0.0001–0.029). More aldosterone hypersecretion from the left adrenal gland was observed in the LCV (n = 28) and CT (n = 25) selected using microcatheter compared to the LAV selected using 5-Fr catheter (n = 6) (p < 0.0001). Diagnostic changes in the laterality from unilateral to bilateral were noted in 3 (8%) patients using microcatheter. Conclusion: Microcatheter can effectively assess aldosterone hypersecretion and the laterality, especially in the LAV. Advances in knowledge: Especially for the left adrenal venous sampling, the tip of microcatheter could certainly reach the left adrenal vein orifice compared with 5-Fr catheter, therefore correct diagnosis is made and this leads to appropriate treatment.

Adrenal Venous Sampling in Young Patients with Primary Aldosteronism. Extravagance or Irreplaceable?

2021 ◽  
Author(s):  
Eleftheria Gkaniatsa ◽  
Augustinas Sakinis ◽  
Magnus Palmér ◽  
Andreas Muth ◽  
Penelope Trimpou ◽  
...  
Keyword(s):  
Primary Aldosteronism ◽  
Clinical Guidelines ◽  
Clinical Success ◽  
Adrenal Adenoma ◽  
Young Patients ◽  
Adrenal Venous Sampling ◽  
Imaging Studies ◽  
Venous Sampling ◽  
Unilateral Adrenalectomy ◽  
Aldosterone Production

Abstract Context Current clinical guidelines suggest that adrenal venous sampling (AVS) may not be mandatory in young patients with primary aldosteronism (PA) and a solitary adrenal adenoma on imaging. Objective The aim of this study was to further elucidate whether conventional imaging alone is sufficient to distinguish unilateral from bilateral PA among patients aged 40 years or younger. Methods This was a retrospective study where data from 45 patients with PA, aged between 26 and 40 years, who underwent successful AVS between 2005 and 2019, were analyzed. Results concerning laterality on imaging studies and AVS were recorded. Outcome in surgically treated patients was assessed according to the Primary Aldosteronism Surgical Outcomes criteria. Results In 4 of 25 patients with unilateral aldosterone production according to AVS, computed tomography inaccurately suggested bilateral disease. Following unilateral adrenalectomy, all 4 patients showed complete clinical success. Five of 20 patients with bilateral aldosterone production according to AVS had a solitary adrenal nodule (8-19 mm) on imaging. Two of these 5 patients were treated with unilateral adrenalectomy, neither having complete biochemical and/or clinical success postoperatively. Two of 16 patients younger than 35 years had discordant results, 1 with unilateral and 1 with bilateral aldosterone production, according to AVS. Conclusion Imaging studies inaccurately predicted laterality in a significant number of young patients with PA. In contrast to current clinical guidelines, our results support AVS for subtype evaluation in young adults with PA, including patients 35 years or younger.

scholarly journals Adrenal Venous Sampling for Primary Aldosteronism and Clinical Outcomes After Unilateral Adrenalectomy: A Single-Center Experience

2009 ◽  
Vol 11 (6) ◽  
pp. 316-323 ◽  
Author(s):  
Miho Murashima ◽  
Scott O. Trerotola ◽  
Douglas L. Fraker ◽  
Dale Han ◽  
Raymond R. Townsend ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Primary Aldosteronism ◽  
Adrenal Venous Sampling ◽  
Single Center ◽  
Venous Sampling ◽  
Unilateral Adrenalectomy ◽  
Single Center Experience

Management of Primary Aldosteronism: Should Adrenal Gland Computed Tomography be Replaced by Adrenal Venous Sampling?

2014 ◽  
Vol 17 (1) ◽  
pp. 23-29
Author(s):  
CH Lam ◽  
◽  
HL Chow ◽  
SH Chiu ◽  
HY Cho ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Adrenal Gland ◽  
Primary Aldosteronism ◽  
Adrenal Venous Sampling ◽  
Venous Sampling

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

2019 ◽  
Vol 7 (10) ◽  
pp. 1895-1899
Author(s):  
Ryo Nakamaru ◽  
Koichi Yamamoto ◽  
Satoko Nozato ◽  
Kazuhiro Hongyo ◽  
Motonori Nagasawa ◽  
...  
Keyword(s):  
Resistant Hypertension ◽  
Primary Aldosteronism ◽  
Adrenal Venous Sampling ◽  
Venous Sampling ◽  
Unilateral Adrenalectomy

Single-center Outcome of Laparoscopic Unilateral Adrenalectomy for Patients With Primary Aldosteronism: Lateralizing Disease Using Results of Adrenal Venous Sampling

Urology ◽  
2011 ◽  
Vol 78 (1) ◽  
pp. 68-73 ◽  
Author(s):  
Shigeto Ishidoya ◽  
Yasuhiro Kaiho ◽  
Akihiro Ito ◽  
Ryo Morimoto ◽  
Fumitoshi Satoh ◽  
...  
Keyword(s):  
Primary Aldosteronism ◽  
Adrenal Venous Sampling ◽  
Single Center ◽  
Venous Sampling ◽  
Unilateral Adrenalectomy

scholarly journals MON-198 Cosyntropin Stimulation on Adrenal Venous Sampling Obscure Surgically Curable Primary Aldosteronism

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Hiroki Kobayashi ◽  
Masanori Abe ◽  
Isao Kurihara ◽  
Takamasa Ichijo ◽  
Yoshiyu Takeda ◽  
...  
Keyword(s):  
Primary Aldosteronism ◽  
Surgical Outcomes ◽  
Surgical Outcome ◽  
Adrenal Adenoma ◽  
Pathological Finding ◽  
Adrenal Venous Sampling ◽  
Venous Sampling ◽  
Acth Stimulation ◽  
Plasma Aldosterone Concentration ◽  
Significant Difference

Abstract Context: While it has been shown that ACTH stimulation during adrenal venous sampling (AVS) for primary aldosteronism (PA) leads to correct lateralization, others showed opposite results. Whether to use ACTH stimulation during AVS for the subtype diagnosis of PA remains unsolved. Objectives: Our purpose of this study is to evaluate the clinical implications of ACTH stimulation during AVS in terms of surgical outcomes. Design and settings: Among JRAS cohort, we allocated 314 patients with both basal and ACTH-stimulated AVS data who underwent adrenalectomy to 3 groups: basal lateralization index (LI)≥2 with ACTH-stimulated LI ≥4 on the ipsilateral side (Unilateral (U) to U group, n=245); basal LI &lt;2 with ACTH-stimulated LI ≥4 (n=15); basal LI≥2 with ACTH-stimulated LI &lt;4 (U to Bilateral (B) group, n=54). We compared surgical outcomes among the groups. Results: Compared with the U to U group, the U to B group had poor clinical and biochemical outcomes and low rates of adrenal adenoma as a pathological finding. All patients in the U to Bgroup with clinical and biochemical benefits however had adrenal adenoma as a pathological finding and could be well differentiated from those with poor surgical outcome via basal LI, but not ACTH-stimulated LI. A receiver operating characteristic curve analysis demonstrated that the cut-off value of 8.3 showed the specificity of 84% for the prediction of good surgical outcome in U to B group.These results were similar even when we defined each group based on a cut-off value of 4 for basal LI. Although, the basal plasma aldosterone concentration (PAC) in the adrenal veins on both dominant and non-dominant sides among patients with better surgical outcome in the U to B group were not significantly different from those in the U to U group, there was a significant difference in the ACTH-stimulated PAC on the dominant side. Conclusions: We demonstrated novel findings showing that patients in the U to B group were shown to be comprised of 2 groups with good and poor surgical outcomes, and basal LI was useful in identifying PA patients with good surgical outcome in U to B group. The low expression level of MC2R receptor on aldosterone-producing adenoma (APA) might be the explanation of the weak response in aldosterone level in a proportion of surgically curable APA cases. These findings point to the important fact that ACTH stimulation on AVS obscure surgically curable cases of PA.

scholarly journals Effect of cosyntropin during adrenal venous sampling on subtype of primary aldosteronism: analysis of surgical outcome

2020 ◽  
Vol 182 (3) ◽  
pp. 265-273
Author(s):  
Hiroki Kobayashi ◽  
Yoshihiro Nakamura ◽  
Masanori Abe ◽  
Isao Kurihara ◽  
Hiroshi Itoh ◽  
...  
Keyword(s):  
Primary Aldosteronism ◽  
Surgical Outcomes ◽  
Surgical Outcome ◽  
Adrenal Adenoma ◽  
Adrenal Venous Sampling ◽  
Pathological Findings ◽  
Venous Sampling ◽  
Acth Stimulation ◽  
Well Differentiated ◽  
Lateralization Index

Objectives We investigated the clinical significance of ACTH stimulation during adrenal venous sampling (AVS) by surgical outcome of primary aldosteronism (PA). Design Multicenter retrospective study by Japan PA study. Method We allocated 314 patients with both basal and ACTH-stimulated AVS data who underwent adrenalectomy to three groups: basal lateralization index (LI) ≥2 with ACTH-stimulated LI ≥4 on the ipsilateral side (Unilateral (U) to U group, n = 245); basal LI <2 with ACTH-stimulated LI ≥4 (Bilateral (B) to U group, n = 15); and basal LI ≥2 with ACTH-stimulated LI <4 (U to B group, n = 54). We compared surgical outcomes among the groups using the Primary Aldosteronism Surgical Outcome (PASO) criteria. Results Compared with U to U group, U to B group had poor clinical and biochemical outcomes and low rates of adrenal adenoma as pathological findings (P = 0.044, 0.006, and 0.048, respectively), although there were no significant differences between U to U and B to U groups. All patients in U to B group with clinical and biochemical benefits, however, had adrenal adenoma as pathological findings and could be well differentiated from those with poor surgical outcomes via basal LI (>8.3), but not ACTH-stimulated LI. These results were similar even when we defined each group based on a cut-off value of 4 for basal LI. Conclusions Although PA patients in U to B group had worse surgical outcomes than did those in U to U group, basal LI could discriminate among patients with better surgical outcomes in U to B group.

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