scholarly journals A Case of Primary Aldosteronism Due to A Primary Adrenal Adenoma Diagnosed by Segmental Adrenal Venous Sampling (S-AVS) Using a Modified Catheter System and Lateral Cine Angiography

2019 ◽  
Vol 20 ◽  
pp. 139-145 ◽  
Author(s):  
Keisuke Okamura ◽  
Tetsu Okuda ◽  
Yusuke Fukuda ◽  
Yosuke Takamiya ◽  
Kazuyuki Shirai ◽  
...  
Keyword(s):  
Primary Aldosteronism ◽  
Adrenal Adenoma ◽  
Adrenal Venous Sampling ◽  
Venous Sampling ◽  
Catheter System ◽  
Cine Angiography

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 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 <2 with ACTH-stimulated LI ≥4 (n=15); basal LI≥2 with ACTH-stimulated LI <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.

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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