scholarly journals Correlation Between Lateralization Index of Adrenal Venous Sampling and Standardized Outcome in Primary Aldosteronism

2018 ◽  
Vol 2 (8) ◽  
pp. 893-902 ◽  
Author(s):  
Hironobu Umakoshi ◽  
Mika Tsuiki ◽  
Maki Yokomoto-Umakoshi ◽  
Yoshiyu Takeda ◽  
Yoneda Takashi ◽  
...  
Keyword(s):  
Primary Aldosteronism ◽  
Adrenal Venous Sampling ◽  
Venous Sampling ◽  
Lateralization Index

scholarly journals Variability of Aldosterone Measurements During Adrenal Venous Sampling for Primary Aldosteronism

2020 ◽  
Author(s):  
Nicholas Yozamp ◽  
Gregory L Hundemer ◽  
Marwan Moussa ◽  
Johnathan Underhill ◽  
Tali Fudim ◽  
...  
Keyword(s):  
Primary Aldosteronism ◽  
Vena Cava ◽  
Adrenal Venous Sampling ◽  
Venous Sampling ◽  
Tertiary Referral Center ◽  
Percentage Difference ◽  
Left And Right ◽  
The Mean ◽  
Lateralization Index ◽  
Cortisol Ratio

Abstract BACKGROUND Variability of aldosterone concentrations has been described in patients with primary aldosteronism. METHODS We performed a retrospective cohort study of 340 patients with primary aldosteronism who underwent adrenal venous sampling (AVS) at a tertiary referral center, 116 of whom also had a peripheral venous aldosterone measured hours before the procedure. AVS was performed by the same interventional radiologist using bilateral, simultaneous sampling, under unstimulated and then stimulated conditions, and each sample was obtained in triplicate. Main outcome measures were: (i) change in day of AVS venous aldosterone from pre-AVS to intra-AVS and (ii) variability of triplicate adrenal venous aldosterone concentrations during AVS. RESULTS Within an average duration of 131 minutes, 81% of patients had a decline in circulating aldosterone concentrations (relative decrease of 51% and median decrease of 7.0 ng/dl). More than a quarter (26%) of all patients had an inferior vena cava aldosterone of ≤5 ng/dl at AVS initiation. The mean coefficient of variation of triplicate adrenal aldosterone concentrations was 30% and 39%, in the left and right veins, respectively (corresponding to a percentage difference of 57% and 73%), resulting in lateralization discordance in up to 17% of patients if the lateralization index were calculated using only one unstimulated aldosterone-to-cortisol ratio rather than the average of triplicate measures. CONCLUSIONS Circulating aldosterone levels can reach nadirs conventionally considered incompatible with the primary aldosteronism diagnosis, and adrenal venous aldosterone concentrations exhibit acute variability that can confound AVS interpretation. A single venous aldosterone measurement lacks precision and reproducibility in primary aldosteronism.

scholarly journals Adrenocorticotropic Hormone–Stimulated Adrenal Venous Sampling Underestimates Surgically Curable Primary Aldosteronism: A Retrospective Cohort Study and Review of Contemporary Studies

Hypertension ◽  
2021 ◽  
Author(s):  
Nicholas Yozamp ◽  
Gregory L. Hundemer ◽  
Marwan Moussa ◽  
Jonathan Underhill ◽  
Tali Fudim ◽  
...  
Keyword(s):  
Primary Aldosteronism ◽  
Adrenocorticotropic Hormone ◽  
Adrenal Venous Sampling ◽  
Original Research ◽  
Venous Sampling ◽  
Acth Stimulation ◽  
The Past ◽  
Unilateral Disease ◽  
The Impact ◽  
Lateralization Index

Guidelines recommend adrenal venous sampling to determine disease laterality in primary aldosteronism. Adrenocorticotropic hormone (ACTH) stimulation clearly improves the likelihood of successful adrenal vein catheterization but may lead to a decrease in lateralization rates. To examine the impact of ACTH on lateralization, we performed a retrospective analysis of 340 patients with confirmed primary aldosteronism who underwent adrenal venous sampling with a single interventional radiology team using a protocol of sampling both before and after an ACTH bolus. In addition to this original research, we conducted a review of similar studies from the past 5 years to develop a consensus on the impact of ACTH on lateralization for primary aldosteronism. In the original research analysis, following a bolus of ACTH, 58% of patients had a decline in lateralization index which led to discordance between the pre-ACTH and post-ACTH classifications of lateralization in up to 26% of cases. The majority of discordant cases were due to reclassification from unilateral disease pre-ACTH to bilateral disease post-ACTH. In patients who already lateralized with unstimulated sampling, the response to ACTH did not have any impact on surgical outcomes. In a review of contemporary studies, we identified 11 similar studies in the past 5 years, of which 10 reported either no change or a decrease in lateralization index following ACTH, resulting in ≈25% discordance between unstimulated and stimulated lateralization rates. We conclude that ACTH stimulation during adrenal venous sampling can underestimate surgically remediable primary aldosteronism and recommend that the role of ACTH be limited primarily to enhancing selectivity.

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.

Historical changes and between-facility differences in adrenal venous sampling for primary aldosteronism in Japan

2019 ◽  
Vol 34 (1) ◽  
pp. 34-42 ◽  
Author(s):  
Yuichi Fujii ◽  
◽  
Yoshiyu Takeda ◽  
Isao Kurihara ◽  
Hiroshi Itoh ◽  
...  
Keyword(s):  
Primary Aldosteronism ◽  
Adrenal Venous Sampling ◽  
Venous Sampling ◽  
Historical Changes

Primary Aldosteronism: Effect of Different Protocols on Lateralization by Adrenal Venous Sampling

2011 ◽  
pp. P2-604-P2-604
Author(s):  
Akiyo Tanabe ◽  
Mika Tsuiki ◽  
Aya Tsumagari ◽  
Hitomi Kimura ◽  
Mitsuhide Naruse ◽  
...  
Keyword(s):  
Primary Aldosteronism ◽  
Adrenal Venous Sampling ◽  
Venous Sampling

scholarly journals Functional imaging by 11C-metomidate PET: a really useless technique for Primary Aldosteronism subtyping?

2021 ◽  
Author(s):  
Filippo Crimì ◽  
Alessandro Spimpolo ◽  
Diego Cecchin ◽  
Gian Paolo Rossi
Keyword(s):  
Diagnostic Accuracy ◽  
Functional Imaging ◽  
Primary Aldosteronism ◽  
Adrenal Venous Sampling ◽  
Venous Sampling ◽  
Endocrine Society ◽  
Great Caution ◽  
Diagnostic Usefulness

Soinio et al. recently compared the diagnostic accuracy of 11C-metomidate PET (11C-MTO-PET) and cosyntropin-stimulated adrenal venous sampling (AVS) for the subtyping of patients with primary aldosteronism (PA), who were diagnosed according to the 2008 Endocrine Society guidelines. They concluded that 11C-MTO-PET offered no diagnostic usefulness in subtyping of PA patients. In our view, this conclusion needs to be taken with great caution owing to a number of concerns that can be raised concerning their study

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