1
|
Liu J, Shao S, Wang Q, Zhang Z, Ding X, Zhao L, Wang J, Ji X, Dai Q, Du M, Zhang Z. Antecubital vein combined with femoral vein pathway could shorten the learning curve of simultaneous bilateral adrenal vein sampling. J Clin Hypertens (Greenwich) 2024; 26:635-644. [PMID: 38751037 PMCID: PMC11180688 DOI: 10.1111/jch.14828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 04/05/2024] [Accepted: 04/12/2024] [Indexed: 06/18/2024]
Abstract
During our previous bilateral adrenal vein sampling (AVS) procedure, the authors observed that accessing the left adrenal vein through the antecubital vein was more feasible than the conventional femoral vein. Meanwhile, the femoral vein pathway facilitated access to the right adrenal vein than the antecubital vein pathway. Therefore, the authors hypothesized that simultaneous bilateral AVS via the antecubital combined with the femoral vein pathway could improve the success rate. A total of 94 cases of AVS via the antecubital combined with the femoral vein pathway were performed, while the remaining 20 cases employed the antecubital vein pathway at our center between August 2020 and April 2023. Furthermore, a meta-analysis was conducted in this study using 15 selected articles to determine the success rate of AVS in each center and pathway. The success rate of ACTH-stimulated simultaneous bilateral AVS via the antecubital vein combined with the femoral vein pathway was 92.85% (P = .503) on the right and 95.00% (P < .001) on the left. In the antecubital vein pathway, the success rates were only 25.00% (P < .001) on the right side and 80.00% (P = .289) on the left side. The results of meta-analysis demonstrated a success rate of 78.16% on the right and 94.98% on the left for ACTH-stimulated AVS via the femoral vein pathway. Based on our center's experience, simultaneous bilateral adrenal vein sampling via the combined pathway could improve the success rate of AVS in the short term and shorten the learning curve.
Collapse
Affiliation(s)
- Jiaqi Liu
- Department of CardiologyShanghai General Hospital (originally named Shanghai First People’s Hospital), Shanghai Jiaotong University School of medicineShanghaiChina
| | - Shuai Shao
- Department of CardiologyShanghai General Hospital (originally named Shanghai First People’s Hospital), Shanghai Jiaotong University School of medicineShanghaiChina
| | - Qiuli Wang
- Department of NursingShanghai General Hospital (originally named Shanghai First People’s Hospital), Shanghai Jiaotong University School of medicineShanghaiChina
| | - Zhiping Zhang
- Department of CardiologyShanghai General Hospital (originally named Shanghai First People’s Hospital), Shanghai Jiaotong University School of medicineShanghaiChina
| | - Xiaoying Ding
- Department of EndocrinologyShanghai General Hospital (originally named Shanghai First People’s Hospital), Shanghai Jiaotong University School of medicineShanghaiChina
| | - Li Zhao
- Department of EndocrinologyShanghai General Hospital (originally named Shanghai First People’s Hospital), Shanghai Jiaotong University School of medicineShanghaiChina
| | - Jinliang Wang
- School of Health Science and EngineeringUniversity of Shanghai for Science and TechnologyShanghaiChina
| | - Xiaohong Ji
- Department of NursingShanghai General Hospital (originally named Shanghai First People’s Hospital), Shanghai Jiaotong University School of medicineShanghaiChina
| | - Qiuyan Dai
- Department of CardiologyShanghai General Hospital (originally named Shanghai First People’s Hospital), Shanghai Jiaotong University School of medicineShanghaiChina
| | - Mingli Du
- Department of NursingShanghai General Hospital (originally named Shanghai First People’s Hospital), Shanghai Jiaotong University School of medicineShanghaiChina
| | - Zhi Zhang
- Department of CardiologyShanghai General Hospital (originally named Shanghai First People’s Hospital), Shanghai Jiaotong University School of medicineShanghaiChina
| |
Collapse
|
2
|
Wernig F, Dunin-Borkowska A, Frisiras A, Khoo B, Todd J, Di Marco A, Palazzo FF, Barnes SC, Tan TM, Meeran K, Alsafi A. Adrenal Vein Sampling: Does the Location of the Non-adrenal Venous Sample Matter? Cardiovasc Intervent Radiol 2024; 47:194-199. [PMID: 38212421 PMCID: PMC10844346 DOI: 10.1007/s00270-023-03647-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 12/07/2023] [Indexed: 01/13/2024]
Abstract
PURPOSE Adrenal vein sampling (AVS) is used to lateralise and differentiate unilateral from bilateral aldosterone production in primary aldosteronism. The adrenal venous samples are standardised to a peripheral or low inferior vena cava (IVC) sample and compared. It is unknown whether the location of the non-adrenal sample affects the results. This study compares AVS results standardised to the low IVC and right external iliac vein (REIV). METHODS Patients who underwent AVS between March 2021 and May 2023 were included. All procedures were undertaken by a single operator (AA). Demographic data and AVS results were collected from patients' electronic records. Catheterisation success and lateralisation were assessed using both low IVC and REIV samples. Equivalence test was used to compare the cortisol and aldosterone levels. RESULTS Eighty-one patients, (M: F = 38:43), aged between 29 and 74 were included. Bilateral successful adrenal vein cannulation was achieved in 79/81 (97.5%) cases. The mean cortisol levels from the REIV were statistically equivalent although there was a small and not biologically significant difference from the low IVC (respective geometric means 183 nmol/l vs. 185 nmol/l, p = 0.015). This small difference in cortisol may be due to accessory adrenal venous drainage into the IVC. The aldosterone and aldosterone/cortisol ratios were statistically equivalent. There was no discordance in selectivity or lateralisation when the IVC or REIV measurements were used. CONCLUSION The IVC and REIV samples may be used interchangeably during AVS.
Collapse
Affiliation(s)
- Florian Wernig
- Department of Endocrinology, Imperial College Healthcare NHS Trust, London, UK
- Division of Diabetes, Endocrinology and Metabolism, Imperial College London, London, UK
| | - Aleksandra Dunin-Borkowska
- Imaging Department, Hammersmith Hospital, Imperial College Healthcare NHS Trust, Du Cane Road, London, W12 0HS, UK
| | - Angelos Frisiras
- Imaging Department, Hammersmith Hospital, Imperial College Healthcare NHS Trust, Du Cane Road, London, W12 0HS, UK
| | - Bernard Khoo
- Department of Endocrinology, Division of Medicine, Royal Free Campus, University College London, London, UK
| | - Jeannie Todd
- Department of Endocrinology, Imperial College Healthcare NHS Trust, London, UK
- Division of Diabetes, Endocrinology and Metabolism, Imperial College London, London, UK
| | - Aimee Di Marco
- Department of Endocrine Surgery, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
- Department of Surgery & Cancer, Imperial College, London, UK
| | - F Fausto Palazzo
- Department of Endocrine Surgery, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
- Department of Surgery & Cancer, Imperial College, London, UK
| | - Sophie C Barnes
- Department of Clinical Biochemistry, North-West London Pathology, London, UK
| | - Tricia M Tan
- Department of Endocrinology, Imperial College Healthcare NHS Trust, London, UK
- Division of Diabetes, Endocrinology and Metabolism, Imperial College London, London, UK
| | - Karim Meeran
- Department of Endocrinology, Imperial College Healthcare NHS Trust, London, UK
- Division of Diabetes, Endocrinology and Metabolism, Imperial College London, London, UK
| | - Ali Alsafi
- Imaging Department, Hammersmith Hospital, Imperial College Healthcare NHS Trust, Du Cane Road, London, W12 0HS, UK.
- Department of Surgery & Cancer, Imperial College, London, UK.
| |
Collapse
|
3
|
Ng E, Gwini SM, Zheng W, Fuller PJ, Yang J. Predicting Bilateral Subtypes of Primary Aldosteronism Without Adrenal Vein Sampling: A Systematic Review and Meta-analysis. J Clin Endocrinol Metab 2024; 109:e837-e855. [PMID: 37531636 DOI: 10.1210/clinem/dgad451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 06/19/2023] [Accepted: 07/31/2023] [Indexed: 08/04/2023]
Abstract
CONTEXT Primary aldosteronism (PA) is the most common endocrine cause of hypertension. The final diagnostic step involves subtyping, using adrenal vein sampling (AVS), to determine if PA is unilateral or bilateral. The complete PA diagnostic process is time and resource intensive, which can impact rates of diagnosis and treatment. Previous studies have developed tools to predict bilateral PA before AVS. OBJECTIVE Evaluate the sensitivity and specificity of published tools that aim to identify bilateral subtypes of PA. METHODS Medline and Embase databases were searched to identify published models that sought to subtype PA, and algorithms to predict bilateral PA are reported. Meta-analysis and meta-regression were then performed. RESULTS There were 35 studies included, evaluating 55 unique algorithms to predict bilateral PA. The algorithms were grouped into 6 categories: those combining biochemical, radiological, and demographic characteristics (A); confirmatory testing alone or combined with biochemical, radiological, and demographic characteristics (B); biochemistry results alone (C); adrenocorticotropic hormone stimulation testing (D); anatomical imaging (E); and functional imaging (F). Across the identified algorithms, sensitivity and specificity ranged from 5% to 100% and 36% to 100%, respectively. Meta-analysis of 30 unique predictive tools from 32 studies showed that the group A algorithms had the highest specificity for predicting bilateral PA, while group F had the highest sensitivity. CONCLUSIONS Despite the variability in published predictive algorithms, they are likely important for decision-making regarding the value of AVS. Prospective validation may enable medical treatment upfront for people with a high likelihood of bilateral PA without the need for an invasive and resource-intensive test.
Collapse
Affiliation(s)
- Elisabeth Ng
- Centre for Endocrinology & Metabolism, Hudson Institute of Medical Research, Clayton, Australia
- Department of Endocrinology, Monash Health, Clayton, Australia
- Department of Molecular and Translational Science, Monash University, Clayton, Australia
| | - Stella May Gwini
- Centre for Endocrinology & Metabolism, Hudson Institute of Medical Research, Clayton, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Winston Zheng
- Department of Endocrinology, Monash Health, Clayton, Australia
| | - Peter J Fuller
- Centre for Endocrinology & Metabolism, Hudson Institute of Medical Research, Clayton, Australia
- Department of Endocrinology, Monash Health, Clayton, Australia
- Department of Molecular and Translational Science, Monash University, Clayton, Australia
| | - Jun Yang
- Centre for Endocrinology & Metabolism, Hudson Institute of Medical Research, Clayton, Australia
- Department of Endocrinology, Monash Health, Clayton, Australia
- Department of Molecular and Translational Science, Monash University, Clayton, Australia
- Department of Medicine, Monash University, Clayton, Australia
| |
Collapse
|
4
|
Zheng Y, Long T, Peng N, Zhen M, Ye Q, Zhang Z, He Y, Chen Z, Gan Y, Luo M, Li C, Liu Z, Guo M, Wang M, Luo X, Hu S, Liu L, Jiang T. The Value of Targeting CXCR4 With 68Ga-Pentixafor PET/CT for Subtyping Primary Aldosteronism. J Clin Endocrinol Metab 2023; 109:171-182. [PMID: 37477496 DOI: 10.1210/clinem/dgad421] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 06/26/2023] [Accepted: 07/12/2023] [Indexed: 07/22/2023]
Abstract
CONTEXT Primary aldosteronism (PA) is one of the leading causes of secondary hypertension, and its diagnostic subtyping consistently presents a clinical challenge. OBJECTIVE This study aimed to investigate the potential of 68Ga-Pentixafor positron emission tomography/computed tomography (PET/CT) in PA classification and its applicability in guiding the development of clinical treatment plans by increasing the sample size. METHODS We prospectively enrolled 120 patients with either PA or nonfunctional adenoma (NFA) for analysis. All patients underwent 68Ga-Pentixafor PET/CT. Of these, 11 patients underwent adrenal venous sampling (AVS), 77 underwent adrenalectomy, 76 received pathological diagnoses, and 71 underwent immunohistochemical detection of aldosterone synthase (CYP11B2). Immunohistochemistry for C-X-C chemokine receptor 4 (CXCR4) was performed in 62 cases. Follow-up was conducted for all patients. RESULTS Among the 120 patients, 66 were diagnosed with aldosterone-producing adenoma (APA), 33 with idiopathic hyperaldosteronism (IHA), and 21 with NFA. For APA patients, the sensitivity, specificity, and accuracy of visual analysis using 68Ga-Pentixafor PET/CT were 92.40%, 94.40%, and 93.33%, respectively. Furthermore, for APA patients with a nodule greater than 1 cm in diameter, when the maximum standard uptake value was 7.3 or greater, the specificity was 100%; and for APA patients with a nodule less than 1 cm in diameter, 68Ga-Pentixafor PET/CT also exhibited high sensitivity. AVS was successfully performed in 5 patients. Among the 5 patients, the concordance rate between the AVS and 68Ga-Pentixafor PET/CT for PA subtyping was 60%. In the 77 patients who underwent adrenalectomy, 61 PET/CT scans displayed positive lesions, all of which benefited from the surgery. Additionally, the concordance rate between 68Ga-Pentixafor PET/CT imaging and CYP11B2 was 81.69%. CONCLUSION 68Ga-Pentixafor PET/CT is a reliable and noninvasive functional imaging technique that demonstrates high accuracy in classifying PA and provides valuable guidance for clinical treatment decision-making.
Collapse
Affiliation(s)
- Yanqing Zheng
- Department of Endocrinology, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China
| | - Tingting Long
- Department of Nuclear Medicine, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China
| | - Ning Peng
- Department of Endocrinology, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China
| | - Mengling Zhen
- Department of Endocrinology, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China
| | - Qianwen Ye
- Department of Endocrinology, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China
| | - Zhen Zhang
- Department of Endocrinology, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China
| | - Yao He
- Department of Urology, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China
| | - Zhi Chen
- Department of Urology, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China
| | - Yu Gan
- Department of Urology, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China
| | - Min Luo
- Department of Endocrinology, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China
| | - Chun Li
- Department of Endocrinology, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China
| | - Zehao Liu
- Department of Endocrinology, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China
| | - Min Guo
- Department of Endocrinology, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China
| | - Min Wang
- Department of Endocrinology, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China
| | - Xianghang Luo
- Department of Endocrinology, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China
| | - Shuo Hu
- Department of Nuclear Medicine, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China
| | - Longfei Liu
- Department of Urology, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China
| | - Tiejian Jiang
- Department of Endocrinology, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China
| |
Collapse
|
5
|
Ha J, Park JH, Kim KJ, Kim JH, Jung KY, Lee J, Choi JH, Lee SH, Hong N, Lim JS, Park BK, Kim JH, Jung KC, Cho J, Kim MK, Chung CH. 2023 Korean Endocrine Society Consensus Guidelines for the Diagnosis and Management of Primary Aldosteronism. Endocrinol Metab (Seoul) 2023; 38:597-618. [PMID: 37828708 PMCID: PMC10765003 DOI: 10.3803/enm.2023.1789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 08/31/2023] [Accepted: 09/06/2023] [Indexed: 10/14/2023] Open
Abstract
Primary aldosteronism (PA) is a common, yet underdiagnosed cause of secondary hypertension. It is characterized by an overproduction of aldosterone, leading to hypertension and/or hypokalemia. Despite affecting between 5.9% and 34% of patients with hypertension, PA is frequently missed due to a lack of clinical awareness and systematic screening, which can result in significant cardiovascular complications. To address this, medical societies have developed clinical practice guidelines to improve the management of hypertension and PA. The Korean Endocrine Society, drawing on a wealth of research, has formulated new guidelines for PA. A task force has been established to prepare PA guidelines, which encompass epidemiology, pathophysiology, clinical presentation, diagnosis, treatment, and follow-up care. The Korean clinical guidelines for PA aim to deliver an evidence-based protocol for PA diagnosis, treatment, and patient monitoring. These guidelines are anticipated to ease the burden of this potentially curable condition.
Collapse
Affiliation(s)
- Jeonghoon Ha
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jung Hwan Park
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Kyoung Jin Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Jung Hee Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Kyong Yeun Jung
- Department of Internal Medicine, Nowon Eulji Medical Center, Eulji University School of Medicine, Seoul, Korea
| | - Jeongmin Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jong Han Choi
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Seung Hun Lee
- Division of Endocrinology and Metabolism, Department of Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Namki Hong
- Department of Internal Medicine, Endocrine Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Jung Soo Lim
- Department of Internal Medicine and Research Institute of Metabolism and Inflammation, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Byung Kwan Park
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jung-Han Kim
- Departments of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyeong Cheon Jung
- Department of Pathology, Seoul National University College of Medicine, Seoul, Korea
| | - Jooyoung Cho
- Department of Laboratory Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Mi-kyung Kim
- Department of Internal Medicine, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Choon Hee Chung
- Department of Internal Medicine and Research Institute of Metabolism and Inflammation, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - The Committee of Clinical Practice Guideline of Korean Endocrine Society
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Nowon Eulji Medical Center, Eulji University School of Medicine, Seoul, Korea
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea
- Division of Endocrinology and Metabolism, Department of Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- Department of Internal Medicine, Endocrine Research Institute, Yonsei University College of Medicine, Seoul, Korea
- Department of Internal Medicine and Research Institute of Metabolism and Inflammation, Yonsei University Wonju College of Medicine, Wonju, Korea
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Departments of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Department of Pathology, Seoul National University College of Medicine, Seoul, Korea
- Department of Laboratory Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
- Department of Internal Medicine, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - The Korean Adrenal Study Group of Korean Endocrine Society
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Nowon Eulji Medical Center, Eulji University School of Medicine, Seoul, Korea
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea
- Division of Endocrinology and Metabolism, Department of Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- Department of Internal Medicine, Endocrine Research Institute, Yonsei University College of Medicine, Seoul, Korea
- Department of Internal Medicine and Research Institute of Metabolism and Inflammation, Yonsei University Wonju College of Medicine, Wonju, Korea
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Departments of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Department of Pathology, Seoul National University College of Medicine, Seoul, Korea
- Department of Laboratory Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
- Department of Internal Medicine, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| |
Collapse
|
6
|
Zuo R, Liu S, Xu L, Pang H. Key to the Treatment of Primary Aldosteronism in Secondary Hypertension: Subtype Diagnosis. Curr Hypertens Rep 2023; 25:471-480. [PMID: 37787864 DOI: 10.1007/s11906-023-01269-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/12/2023] [Indexed: 10/04/2023]
Abstract
PURPOSE OF REVIEW Primary aldosteronism (PA) is a leading global cause of secondary hypertension. Subtyping diagnosis of PA is the key to surgery, but accurate classification of PA is crucial but challenging in clinical diagnosis and treatment. The purpose of this review is to provide a summary of current literature and propose subtyping diagnosis flow chart to help us classify PA quickly and accurately. RECENT FINDINGS Early diagnosis and accurate typing are essential for the timely treatment and appropriate management of PA. For most patients, adrenal venous sampling (AVS) is the central choice for typing diagnosis, but AVS is invasive and difficult to promote effectively. CT can help identify unilateral typical adenomas in select patients to avoid AVS. New radionuclide imaging has shown value in the diagnosis and classification of PA, which distinguishes adrenocortical hyperplasia from adenoma and can replace AVS in some patients. Accurately diagnosing unilateral PA is crucial for determining the appropriate treatment strategy for PA. The simple flow chart of PA subtyping diagnosis based on the current literature needs to be verified and evaluated by follow-up researches.
Collapse
Affiliation(s)
- Rui Zuo
- Department of Nuclear Medicine, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Chongqing, 400016, China
| | - Shuang Liu
- Department of Nuclear Medicine, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Chongqing, 400016, China
| | - Lu Xu
- Department of Nuclear Medicine, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Chongqing, 400016, China
| | - Hua Pang
- Department of Nuclear Medicine, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Chongqing, 400016, China.
| |
Collapse
|
7
|
Beninato T, Duh QY, Long KL, Kiernan CM, Miller BS, Patel S, Randle RW, Wachtel H, Zanocco KA, Zern NK, Drake FT. Challenges and controversies in adrenal surgery: A practical approach. Curr Probl Surg 2023; 60:101374. [PMID: 37770163 DOI: 10.1016/j.cpsurg.2023.101374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Affiliation(s)
- Toni Beninato
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Quan-Yang Duh
- Veterans Affairs Medical Center, San Francisco, San Francisco, CA
| | | | - Colleen M Kiernan
- Vanderbilt University Medical Center, Veterans Affairs Medical Center, Tennessee Valley Health System, Nashville, TN
| | - Barbra S Miller
- Division of Surgical Oncology, The Ohio State University, Columbus, OH
| | - Snehal Patel
- Emory University School of Medicine, Atlanta, GA
| | | | | | - Kyle A Zanocco
- David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA
| | | | | |
Collapse
|
8
|
Iwamoto Y, Kimura T, Ohnishi M, Kusano T, Takenouchi H, Iwamoto H, Sanada J, Fushimi Y, Katakura Y, Tatsumi F, Shimoda M, Nakanishi S, Kaku K, Mune T, Kaneto H. Simple standing test without furosemide is useful in the diagnosis of primary aldosteronism. Sci Rep 2023; 13:13381. [PMID: 37591913 PMCID: PMC10435472 DOI: 10.1038/s41598-023-40574-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 08/13/2023] [Indexed: 08/19/2023] Open
Abstract
Primary aldosteronism (PA) is a well-known cause of secondary hypertension. We have long performed the simple standing test in patients with PA. On the other hand, there are few reports on the usefulness of the simple standing test in PA. This study is a single-center, retrospective, observational study. A total of 173 patients with hypertension or adrenal tumor admitted to Kawasaki Medical School were included. Eighty patients who met the exclusion criteria were excluded, and 31 patients without PA (non-PA), 26 patients with unilateral PA, and 36 patients with bilateral PA were included in the study. The simple standing test was performed after 120 min of standing or sitting followed, and the aldosterone/renin ratio (ARR) and percentage of increase plasma aldosterone concentration (%increase of PAC) was calculated. The mean ARR in the simple standing test in unilateral PA (1143 (528-2200)) and bilateral PA subjects (521 (374-765)) were significantly higher compared to non-PA subjects (152 (102-240)) (p < 0.0001, p = 0.0013, respectively). The percentage increase of PAC after standing loading was significantly lower in unilateral PA subjects (110 (96-140)) compared to non-PA subjects (187 (155-244)) (p = 0.0003), with no difference between non-PA and bilateral PA subjects (p = 0.99). The cutoff value of the ARR in the simple standing test for diagnosis of PA in this study was 364 (AUC = 0.948, sensitivity = 83.8%, specificity = 93.5%, false positive rate = 3.7%, false negative rate = 25.6%, p < 0.001), which was not inferior to the diagnostic performance of the captopril loading test. The diagnostic performance of the simple standing test for PA was not inferior to that of the captopril loading test. The percentage increase of PAC in unilateral PA subjects was significantly lower compared to bilateral PA subjects. These results demonstrate the usefulness of the simple standing test, which can be performed simultaneously with general screening tests of PA.
Collapse
Affiliation(s)
- Yuichiro Iwamoto
- Division of Diabetes, Metabolism and Endocrinology, Kawasaki Medical School, 577 Matsushima, Kurashiki, 701-0192, Japan.
| | - Tomohiko Kimura
- Division of Diabetes, Metabolism and Endocrinology, Kawasaki Medical School, 577 Matsushima, Kurashiki, 701-0192, Japan
| | - Mana Ohnishi
- Division of Diabetes, Metabolism and Endocrinology, Kawasaki Medical School, 577 Matsushima, Kurashiki, 701-0192, Japan
| | - Takashi Kusano
- Division of Diabetes, Metabolism and Endocrinology, Kawasaki Medical School, 577 Matsushima, Kurashiki, 701-0192, Japan
| | - Haruka Takenouchi
- Division of Diabetes, Metabolism and Endocrinology, Kawasaki Medical School, 577 Matsushima, Kurashiki, 701-0192, Japan
| | - Hideyuki Iwamoto
- Division of Diabetes, Metabolism and Endocrinology, Kawasaki Medical School, 577 Matsushima, Kurashiki, 701-0192, Japan
| | - Junpei Sanada
- Division of Diabetes, Metabolism and Endocrinology, Kawasaki Medical School, 577 Matsushima, Kurashiki, 701-0192, Japan
| | - Yoshiro Fushimi
- Division of Diabetes, Metabolism and Endocrinology, Kawasaki Medical School, 577 Matsushima, Kurashiki, 701-0192, Japan
| | - Yukino Katakura
- Division of Diabetes, Metabolism and Endocrinology, Kawasaki Medical School, 577 Matsushima, Kurashiki, 701-0192, Japan
| | - Fuminori Tatsumi
- Division of Diabetes, Metabolism and Endocrinology, Kawasaki Medical School, 577 Matsushima, Kurashiki, 701-0192, Japan
| | - Masashi Shimoda
- Division of Diabetes, Metabolism and Endocrinology, Kawasaki Medical School, 577 Matsushima, Kurashiki, 701-0192, Japan
| | - Shuhei Nakanishi
- Division of Diabetes, Metabolism and Endocrinology, Kawasaki Medical School, 577 Matsushima, Kurashiki, 701-0192, Japan
| | - Kohei Kaku
- Division of Diabetes, Metabolism and Endocrinology, Kawasaki Medical School, 577 Matsushima, Kurashiki, 701-0192, Japan
| | - Tomoatsu Mune
- Division of Diabetes, Metabolism and Endocrinology, Kawasaki Medical School, 577 Matsushima, Kurashiki, 701-0192, Japan
| | - Hideaki Kaneto
- Division of Diabetes, Metabolism and Endocrinology, Kawasaki Medical School, 577 Matsushima, Kurashiki, 701-0192, Japan
| |
Collapse
|
9
|
Popoviciu MS, Paduraru L, Nutas RM, Ujoc AM, Yahya G, Metwally K, Cavalu S. Diabetes Mellitus Secondary to Endocrine Diseases: An Update of Diagnostic and Treatment Particularities. Int J Mol Sci 2023; 24:12676. [PMID: 37628857 PMCID: PMC10454882 DOI: 10.3390/ijms241612676] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 07/31/2023] [Accepted: 08/08/2023] [Indexed: 08/27/2023] Open
Abstract
Secondary diabetes mellitus is frequently ignored in specialized literature. In this narrative review, the main endocrinopathies accompanied by increased glycemic values are identified, as well as the mechanisms by which the excess or deficiency of certain hormones impact beta cell function or insulin resistance. The main endocrinopathies (acromegaly, Cushing's syndrome, Basedow-Graves' disease, pheochromocytoma, somatostatinoma and glucagonoma) and their characteristics are described along with the impact of hormone changes on blood sugar, body mass index and other parameters associated with diabetes. The overall information regarding the complex molecular mechanisms that cause the risk of secondary diabetes and metabolic syndrome is of crucial importance in order to prevent the development of the disease and its complications and particularly to reduce the cardiovascular risk of these patients. The purpose of this study is to highlight the particular features of endocrine pathologies accompanied by an increased risk of developing diabetes, in the context of personalized therapeutic decision making. The epidemiological, physiopathological, clinical and therapeutic approaches are presented along with the importance of screening for diabetes in endocrine diseases.
Collapse
Affiliation(s)
- Mihaela Simona Popoviciu
- Faculty of Medicine and Pharmacy, University of Oradea, P-ta 1 Decembrie 10, 410073 Oradea, Romania; (M.S.P.); (L.P.); (S.C.)
| | - Lorena Paduraru
- Faculty of Medicine and Pharmacy, University of Oradea, P-ta 1 Decembrie 10, 410073 Oradea, Romania; (M.S.P.); (L.P.); (S.C.)
| | | | - Alexandra Maria Ujoc
- Bihor County Emergency Clinic Hospital, 410167 Oradea, Romania; (R.M.N.); (A.M.U.)
| | - Galal Yahya
- Department of Microbiology and Immunology, Faculty of Pharmacy, Zagazig University, Zagazig 44519, Egypt
| | - Kamel Metwally
- Department of Medicinal Chemistry, Faculty of Pharmacy, University of Tabuk, Tabuk 71491, Saudi Arabia;
- Department of Pharmaceutical Medicinal Chemistry, Faculty of Pharmacy, Zagazig University, Zagazig 44519, Egypt
| | - Simona Cavalu
- Faculty of Medicine and Pharmacy, University of Oradea, P-ta 1 Decembrie 10, 410073 Oradea, Romania; (M.S.P.); (L.P.); (S.C.)
| |
Collapse
|
10
|
Kann PH. Relevance of Endoscopic Ultrasound in Endocrinology Today: Multiple Endocrine Neoplasia Type 1, Insulinoma, Primary Aldosteronism-An Expert's Perspective Based on Three Decades of Scientific and Clinical Experience. Cancers (Basel) 2023; 15:3494. [PMID: 37444604 DOI: 10.3390/cancers15133494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 06/30/2023] [Accepted: 07/03/2023] [Indexed: 07/15/2023] Open
Abstract
In endocrinology, endoscopic ultrasound (EUS) may be used to image the adrenals, the endocrine pancreas, and other organs where endocrine neoplasms may occur. During the recent decades, EUS has been established predominantly to assess multiple endocrine neoplasia type 1, to localize insulinomas, and to identify aldosterone-producing adenomas. EUS in endocrinology requires special skills and individual experience in order to provide reliable diagnostic information.
Collapse
Affiliation(s)
- Peter Herbert Kann
- German Center for Endocrine Care DEVZ, Düsseldorfer Strasse 1-7, 60329 Frankfurt am Main, Germany
- Faculty of Medicine, Philipp's University, Baldinger Strasse, 35033 Marburg, Germany
| |
Collapse
|
11
|
Huang M, Yang D, Zhang Y, Zhang Y, Mu Y. The value of CT-based energy imaging to discriminate dominant side lesions in primary aldosteronism. Front Endocrinol (Lausanne) 2023; 14:1121388. [PMID: 37124744 PMCID: PMC10140406 DOI: 10.3389/fendo.2023.1121388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 03/27/2023] [Indexed: 05/02/2023] Open
Abstract
Purpose The current clinical discrimination of the dominant side of primary aldosteronism (PA) mainly relies on invasive adrenal venous sampling (AVS) examination. This study investigated the feasibility of dual-energy CT energy imaging parameters as a novel biomarker in identifying bilateral adrenal dominant lesions. Methods Fifty PA patients with bilateral lesions who underwent CT and AVS of the adrenal glands at Shaanxi Provincial People's Hospital from October 2019 to June 2021 were retrospectively analyzed. Forty-eight patients had successful bilateral blood collection and two failed right-sided blood collection due to venous variation. Forty patients who were classified based on AVS underwent unilateral adrenalectomy and pathological findings confirmed adenoma in all cases. Quantitative dual-energy CT parameters were measured for all adrenal lesions, and the differences in dual-energy CT energy spectrum imaging parameters between the dominant and nondominant adrenal lesions were compared. Results Among forty-eight PA patients with bilateral lesions, forty patients with preoperative AVS-determined lesions on the dominant side underwent unilateral adrenalectomy, and eight patients without the dominant side were treated with medication. The iodine concentration difference (ICD) in the arteriovenous phase was more significant in the 40 cases of primary aldosteronism with dominant adrenal lesions than in the nondominant adrenal lesions (1.18 ± 0.45 vs 0.41 ± 0.42). The NICAP was higher in the dominant adrenal lesions than in the non-dominant lesions (0.39 ± 0.39 vs 0.14 ± 0.05). The sensitivity and specificity of the diagnosis of the dominant adrenal lesion were 88.2% and 82.4% using the ICD of 0.68 as the threshold value. Conclusion Conventional CT has lower diagnostic value for dominant adrenal lesions, and CT-based energy imaging can be a new assessment method as a complement to AVS in identifying bilateral dominant adrenal lesions.
Collapse
|
12
|
Nakai K, Manaka K, Sato J, Takeuchi M, Yamazaki Y, Sasano H, Tsurutani Y, Saito J, Nishikawa T, Iiri T, Nangaku M, Makita N. Aldosterone-Producing Adenomas of Increased Size Are Associated With Higher Steroidogenic Activity. J Clin Endocrinol Metab 2022; 107:3045-3054. [PMID: 36074914 DOI: 10.1210/clinem/dgac530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Indexed: 11/19/2022]
Abstract
CONTEXT There are inconsistent results and insufficient evidence as to whether an association exists between the size and aldosterone-producing ability of aldosterone-producing adenomas. OBJECTIVE We further investigated this possible association retrospectively. METHODS A total of 142 cases of primary aldosteronism diagnosed as unilateral by adrenal venous sampling at 2 referral centers between 2009 and 2019 were included. We classified these individuals into small and large tumor groups using a diameter of 14 mm as a cutoff. This size was the median diameter of the tumor on the affected side of the adrenal gland. We compared plasma aldosterone concentration (PAC), plasma renin activity (PRA), PAC to PRA ratio, PAC from a saline infusion test (SIT), urinary aldosterone secretion (uAld), and serum potassium as indices of aldosterone-producing ability between the 2 groups. In some cases, we conducted histopathological evaluations and detection of the KCNJ5 mutation. RESULTS PAC, PAC to PRA ratio, PAC from SIT, and uAld were higher and serum potassium was lower in the large tumor group. PAC, PAC from SIT, uAld, and serum potassium significantly correlated with tumor diameter. PRA was not associated with tumor diameter. Clear cell-dominant cases were more common in the large tumor group, while cases showing a strong expression of CYP11B2 were not significantly different between the groups. KCNJ5 mutations tended to be more common in the large tumor group. CONCLUSION The higher aldosterone-producing ability in larger adenomas can be used to infer the responsible lesion and disease type.
Collapse
Affiliation(s)
- Kazuki Nakai
- Division of Nephrology and Endocrinology, The University of Tokyo Hospital, Tokyo, 113-8655, Japan
- Endocrinology and Diabetes Center, Yokohama Rosai Hospital, Yokohama, 222-0036, Japan
| | - Katsunori Manaka
- Division of Nephrology and Endocrinology, The University of Tokyo Hospital, Tokyo, 113-8655, Japan
| | - Junichiro Sato
- Division of Nephrology and Endocrinology, The University of Tokyo Hospital, Tokyo, 113-8655, Japan
| | - Maki Takeuchi
- Division of Nephrology and Endocrinology, The University of Tokyo Hospital, Tokyo, 113-8655, Japan
| | - Yuto Yamazaki
- Department of Pathology, Tohoku University Graduate School of Medicine, Sendai, 980-8575, Japan
| | - Hironobu Sasano
- Department of Pathology, Tohoku University Graduate School of Medicine, Sendai, 980-8575, Japan
| | - Yuya Tsurutani
- Endocrinology and Diabetes Center, Yokohama Rosai Hospital, Yokohama, 222-0036, Japan
| | - Jun Saito
- Endocrinology and Diabetes Center, Yokohama Rosai Hospital, Yokohama, 222-0036, Japan
| | - Tetsuo Nishikawa
- Endocrinology and Diabetes Center, Yokohama Rosai Hospital, Yokohama, 222-0036, Japan
- Nishikawa Clinic, Yokohama, 222-0033, Japan
| | - Taroh Iiri
- Division of Nephrology and Endocrinology, The University of Tokyo Hospital, Tokyo, 113-8655, Japan
- Department of Pharmacology, St. Marianna University School of Medicine, Kawasaki, 216-8511, Japan
| | - Masaomi Nangaku
- Division of Nephrology and Endocrinology, The University of Tokyo Hospital, Tokyo, 113-8655, Japan
| | - Noriko Makita
- Division of Nephrology and Endocrinology, The University of Tokyo Hospital, Tokyo, 113-8655, Japan
| |
Collapse
|
13
|
Zhang M, Bian G, Tian J, Yang W, Wang X, Chi C. Assessment of biochemical outcomes in patients with primary aldosteronism after adrenalectomy based on CT scan diagnosis of unilateral adenoma without adrenal vein sampling. Front Oncol 2022; 12:944035. [PMID: 36465361 PMCID: PMC9710738 DOI: 10.3389/fonc.2022.944035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 10/24/2022] [Indexed: 10/04/2023] Open
Abstract
PURPOSE The purpose of this study was to assess the surgical outcomes of patients with primary aldosteronism when surgery was based only on CT finding of unilateral adenoma without adrenal vein sampling (AVS). METHODS This is a retrospective review of the records of patients who had undergone retroperitoneal laparoscopic adrenalectomy for primary aldosteronism based on CT scan finding of unilateral adenoma and had a follow-up of at least 6-12 months from January 2012 to December 2020 in a single center; decision for adrenalectomy was based on CT scan, and AVS was not used. The clinical and biochemical outcomes were accessed using the standardized primary aldosteronism surgical outcome (PASO) criteria. Patient's demographics and preoperative factors were analyzed to assess for independent predictor of surgical success. RESULTS According to the PASO criteria, 172 patients finally enrolled in the training dataset, and 20 patients enrolled in the validation dataset. In the training dataset, complete clinical success was achieved in 71 patients (41.3%), partial success in 87 (50.6%), and absent success in 14 (8.1%). Biochemical outcomes showed that 151 patients (87.8%) were completely cured, 14 patients (8.1%) got a partial biochemical success, and an absent biochemical success was found in seven patients (4.1%). Multivariate logistic regression analysis showed that age, body mass index (BMI), tumor size, mean arterial pressure (MAP), and serum potassium were the most independent factors for incomplete biochemical success. Based on the results of statistical analysis, our study constructed a nomogram prognostic evaluation model for patients after unilateral primary aldosterone surgery. CONCLUSIONS Laparoscopic adrenalectomy for patients with primary aldosteronism base on CT scan finding of a unilateral adenoma without AVS had a high rate of complete biochemical cure at 12 months. Risk factors for incomplete biochemical success include age, BMI, tumor size, MAP, and serum potassium. Our study constructed a nomogram prognostic evaluation model for patients after unilateral primary aldosterone surgery. The nomogram accurately and reliably predicted the incomplete biochemical success.
Collapse
Affiliation(s)
| | | | | | | | - Xiaoqing Wang
- Department of Urology, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Changliang Chi
- Department of Urology, The First Hospital of Jilin University, Changchun, Jilin, China
| |
Collapse
|
14
|
Kometani M, Yoneda T, Karashima S, Takeda Y, Tsuiki M, Yasoda A, Kurihara I, Wada N, Katabami T, Sone M, Ichijo T, Tamura K, Ogawa Y, Kobayashi H, Okamura S, Inagaki N, Kawashima J, Fujita M, Oki K, Matsuda Y, Tanabe A, Naruse M. Effect of Intraprocedural Cortisol Measurement on ACTH-stimulated Adrenal Vein Sampling in Primary Aldosteronism. J Endocr Soc 2022; 6:bvac104. [PMID: 35928241 PMCID: PMC9342856 DOI: 10.1210/jendso/bvac104] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Indexed: 11/23/2022] Open
Abstract
Context Adrenocorticotropin (ACTH) loading is used to increase the success rate of adrenal vein sampling (AVS). Objective We aimed to determine the effect of intraprocedural cortisol measurement (ICM) on ACTH-stimulated AVS (AS-AVS) owing to a lack of reliable data on this topic. Methods This multicenter, retrospective, observational study took place in 28 tertiary centers in Japan. Among 4057 patients enrolled, 2396 received both basal AVS (B-AVS) and AS-AVS and were divided into 2 groups according to whether ICM was used. The effect of ICM on AS-AVS was measured. Results In patients who underwent both AVS procedures, the ICM group had significantly higher success rates for both B-AVS and AS-AVS than the non-ICM group did. However, the probability of failure of AS-AVS after a successful B-AVS and the probability of success of AS-AVS after a failed B-AVS were not significantly different in the 2 groups. For subtype diagnosis, propensity-score matching revealed no significant difference between the 2 groups, and the discrepancy rate between B-AVS and AS-AVS for subtype diagnosis was also not significantly different. Conclusion ICM significantly increased the success rate of B-AVS and AS-AVS in protocols in which both AVS procedures were performed and had no effect on subtype diagnosis. However, in protocols in which both AVS procedures were performed, the results suggest ICM may not be necessary when performing AS-AVS if ICM is used only when B-AVS is performed. Our study suggests that ICM during AVS plays an important role and should be recommended.
Collapse
Affiliation(s)
- Mitsuhiro Kometani
- Department of Health Promotion and Medicine of the Future, Kanazawa University Graduate School of Medicine , Kanazawa, Ishikawa 920-8641 , Japan
| | - Takashi Yoneda
- Department of Health Promotion and Medicine of the Future, Kanazawa University Graduate School of Medicine , Kanazawa, Ishikawa 920-8641 , Japan
| | - Shigehiro Karashima
- Department of Health Promotion and Medicine of the Future, Kanazawa University Graduate School of Medicine , Kanazawa, Ishikawa 920-8641 , Japan
| | - Yoshiyu Takeda
- Department of Health Promotion and Medicine of the Future, Kanazawa University Graduate School of Medicine , Kanazawa, Ishikawa 920-8641 , Japan
- Department of Internal Medicine, Asanogawa General Hospital , Kanazawa, Ishikawa 910-8621 , Japan
| | - Mika Tsuiki
- Department of Endocrinology and Metabolism, National Hospital Organization Kyoto Medical Center , Kyoto 612-8555 , Japan
| | - Akihiro Yasoda
- Department of Endocrinology and Metabolism, National Hospital Organization Kyoto Medical Center , Kyoto 612-8555 , Japan
| | - Isao Kurihara
- Department of Endocrinology, Metabolism, and Nephrology, Keio University School of Medicine , Tokyo 160-8582 , Japan
| | - Norio Wada
- Department of Diabetes and Endocrinology, Sapporo City General Hospital , Sapporo 060-8604 , Japan
| | - Takuyuki Katabami
- Division of Metabolism and Endocrinology, Department of Internal Medicine, St. Marianna University School of Medicine, Yokohama City Seibu Hospital , Yokohama 241-0811 , Japan
| | - Masakatsu Sone
- Division of Metabolism and Endocrinology, Department of Internal Medicine, St. Marianna University School of Medicine , Kawasaki, Kanagawa 216-8511 , Japan
| | - Takamasa Ichijo
- Department of Diabetes and Endocrinology, Saiseikai Yokohamashi Tobu Hospital , Yokohama 230-8765 , Japan
| | - Kouichi Tamura
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine , Yokohama 236-0004 , Japan
- Division of Nephrology and Hypertension, Yokohama City University Medical Center , Yokohama 232-0024 , Japan
| | - Yoshihiro Ogawa
- Department of Medicine and Bioregulatory Science, Kyushu University , Fukuoka 812-8582 , Japan
| | - Hiroki Kobayashi
- Division of Nephrology, Hypertension, and Endocrinology, Nihon University School of Medicine , Tokyo 173-8610 , Japan
| | - Shintaro Okamura
- Department of Endocrinology, Tenri Hospital , Tenri 632-0015 , Japan
| | - Nobuya Inagaki
- Department of Diabetes, Endocrinology, and Nutrition, Kyoto University , Kyoto 606-8501 , Japan
| | - Junji Kawashima
- Department of Metabolic Medicine, Faculty of Life Science, Kumamoto University , Kumamoto 860-8556 , Japan
| | - Megumi Fujita
- Division of Nephrology and Endocrinology, University of Tokyo , Tokyo 113-0033 , Japan
| | - Kenji Oki
- Department of Molecular and Internal Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University , Hiroshima 734-8553 , Japan
| | - Yuichi Matsuda
- Department of Cardiology, Sanda City Hospital , Sanda 669-1321 , Japan
| | - Akiyo Tanabe
- Division of Endocrinology, National Center for Global Health and Medicine , Tokyo 162-8655 , Japan
| | - Mitsuhide Naruse
- Endocrine Center, Ijinkai Takeda General Hospital , Kyoto 601-1495 , Japan
| |
Collapse
|
15
|
Chaman Baz AH, van de Wiel E, Groenewoud H, Arntz M, Gotthardt M, Deinum J, Langenhuijsen J. CXCR4-directed [ 68Ga]Ga-PentixaFor PET/CT versus adrenal vein sampling performance: a study protocol for a randomised two-step controlled diagnoStic Trial Ultimately comparing hypertenSion outcome in primary aldosteronism (CASTUS). BMJ Open 2022; 12:e060779. [PMID: 35998969 PMCID: PMC9403157 DOI: 10.1136/bmjopen-2022-060779] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION Primary aldosteronism (PA) is the most common form of secondary hypertension. It is caused by overproduction of aldosterone by either a unilateral aldosterone-producing adenoma (APA) or by bilateral adrenal hyperplasia (BAH). Distinction is crucial, because PA is cured by adrenalectomy in APA and is treated by mineralocorticoid receptor antagonists in BAH. The distinction is currently made by adrenal vein sampling (AVS). AVS is a costly, invasive and complex technical procedure with limited availability and is not superior in terms of outcomes to CT scan-based diagnosis. Thus, there is a need for a cheaper, non-invasive and readily available diagnostic tool in PA. We propose a new diagnostic imaging modality employing the positron emission tomography (PET) tracer [68Ga]Ga-PentixaFor. This tracer has high focal uptake in APAs, whereas low uptake was shown in patients with normal adrenals. Thus, [68Ga]Ga-PentixaFor PET/CT is an imaging modality with the potential to improve subtyping of PA. It is readily available, safe and, as an out-patient procedure, much cheaper diagnostic method than AVS. METHODS AND ANALYSIS We present a two-step randomised controlled trial (RCT) protocol in which we assess the accuracy of [68Ga]Ga-PentixaFor PET/CT in the first step and compare [68Ga]Ga-PentixaFor PET/CT to AVS in the second step. In the first step, the concordance will be determined between [68Ga]Ga-PentixaFor PET/CT and AVS and a concordance probability is calculated with a Bayesian prediction model. In the second step, we will compare [68Ga]Ga-PentixaFor PET/CT and AVS for clinical outcome and intensity of hypertensive drug use defined as daily defined doses in a RCT. ETHICS AND DISSEMINATION Ethics approval was acquired from the medical ethical committee East-Netherlands (METC Oost-Nederland). Results will be disseminated through peer-reviewed articles. TRIAL REGISTRATION NUMBER NL9625.
Collapse
Affiliation(s)
| | | | - Hans Groenewoud
- Department of Epidemiology, Biostatistics and Health Technology Assessment, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Mark Arntz
- Radiology, Radboudumc, Nijmegen, Gelderland, The Netherlands
| | - Martin Gotthardt
- Nuclear Medicine, Radboudumc, Nijmegen, Gelderland, The Netherlands
| | - Jaap Deinum
- Internal Medicine, Radboudumc, Nijmegen, Gelderland, The Netherlands
| | | |
Collapse
|
16
|
Adrenal Venous Sampling Could Be Omitted before Surgery in Patients with Conn’s Adenoma Confirmed by Computed Tomography and Higher Normal Aldosterone Concentration after Saline Infusion Test. Diagnostics (Basel) 2022; 12:diagnostics12071718. [PMID: 35885622 PMCID: PMC9315939 DOI: 10.3390/diagnostics12071718] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 07/08/2022] [Accepted: 07/13/2022] [Indexed: 11/17/2022] Open
Abstract
Purpose: Adrenal venous sampling (AVS) performed to distinguish unilateral and bilateral primary aldosteronism (PA) is invasive and poorly standardized. This study aimed to identify non-invasive characteristics that can select the patients with unilateral PA who could bypass AVS before surgery. Methods: A single-center study collected a total of 450 patients with PA. Development and validation cohorts included 242 and 208 patients. The AVS was successful in 150 and 138 patients from the cohorts, and the unilateral PA was found in 96 and 94 patients, respectively. Clinical factors independently associated with lateralized AVS in multivariable logistic regression were used to construct a unilateral PA prediction score (SCORE). Results: The proposed SCORE was calculated as a sum of the prevalence of adrenal nodule on computed tomography (2 points) and plasma/serum aldosterone concentration ≥ 165 ng/L after the saline infusion test (SIT) (1 point). Importantly, the SCORE = 3 points identified 48% of unilateral PA patients with a specificity of 100% in the development cohort. The zero rate of false-positive classifications was preserved with the same cut-off value in the validation cohort. Conclusions: AVS could be omitted before surgery in patients with typical Conn´s adenoma provided the aldosterone concentration ≥ 165 ng/L after the SIT.
Collapse
|
17
|
Kocjan T, Vidmar G, Popović P, Stanković M. Validation of three novel clinical prediction tools for primary aldosteronism subtyping. Endocr Connect 2022; 11:e210532. [PMID: 35521815 PMCID: PMC9175612 DOI: 10.1530/ec-21-0532] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 04/11/2022] [Indexed: 12/03/2022]
Abstract
The 20-point clinical prediction SPACE score, the aldosterone-to-lowest potassium ratio (APR), aldosterone concentration (AC) and the AC relative reduction rate after saline infusion test (SIT) have recently been proposed for primary aldosteronism (PA) subtyping prior to adrenal vein sampling (AVS). To validate those claims, we performed a retrospective cross-sectional study that included all patients at our center who had positive SIT to confirm PA and were diagnosed with either bilateral disease (BPA) according to AVS or with lateralized disease (LPA) if biochemically cured after adrenalectomy from November 2004 to the end of 2019. Final diagnoses were used to evaluate the diagnostic performance of proposed clinical prediction tools. Our cohort included 144 patients (40 females), aged 32-72 years (mean 54 years); 59 with LPA and 85 with BPA. The originally suggested SPACE score ≤8 and SPACE score >16 rules yielded about 80% positive predictive value (PPV) for BPA and LPA, respectively. Multivariate analyses with the predictors constituting the SPACE score highlighted post-SIT AC as the most important predictor of PA subtype for our cohort. APR-based tool of <5 for BPA and >15 for LPA yielded about 75% PPV for LPA and BPA. The proposed post-SIT AC <8.79 ng/dL criterion yielded 41% sensitivity and 90% specificity, while the relative post-SIT AC reduction rate of >33.8% criterion yielded 80% sensitivity and 51% specificity for BPA prediction. The application of any of the validated clinical prediction tools to our cohort did not predict the PA subtype with the high diagnostic performance originally reported.
Collapse
Affiliation(s)
- Tomaž Kocjan
- Department of Endocrinology, Diabetes and Metabolic Diseases, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Gaj Vidmar
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
- University Rehabilitation Institute, Ljubljana, Slovenia
- FAMNIT, University of Primorska, Koper, Slovenia
| | - Peter Popović
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
- Clinical Institute of Radiology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Milenko Stanković
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
- Clinical Institute of Radiology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| |
Collapse
|
18
|
Sam D, Kline GA, So B, Hundemer GL, Pasieka JL, Harvey A, Chin A, Przybojewski SJ, Caughlin CE, Leung AA. External Validation of Clinical Prediction Models in Unilateral Primary Aldosteronism. Am J Hypertens 2022; 35:365-373. [PMID: 34958097 PMCID: PMC8976177 DOI: 10.1093/ajh/hpab195] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 12/03/2021] [Accepted: 12/22/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Targeted treatment of primary aldosteronism (PA) is informed by adrenal vein sampling (AVS), which remains limited to specialized centers. Clinical prediction models have been developed to help select patients who would most likely benefit from AVS. Our aim was to assess the performance of these models for PA subtyping. METHODS This external validation study evaluated consecutive patients referred for PA who underwent AVS at a tertiary care referral center in Alberta, Canada during 2006–2018. In alignment with the original study designs and intended uses of the clinical prediction models, the primary outcome was the presence of lateralization on AVS. Model discrimination was evaluated using the C-statistic. Model calibration was assessed by comparing the observed vs. predicted probability of lateralization in the external validation cohort. RESULTS The validation cohort included 342 PA patients who underwent AVS (mean age, 52.1 years [SD, 11.5]; 201 [58.8%] male; 186 [54.4%] with lateralization). Six published models were assessed. All models demonstrated low-to-moderate discrimination in the validation set (C-statistics; range, 0.60–0.72), representing a marked decrease compared with the derivation sets (range, 0.80–0.87). Comparison of observed and predicted probabilities of unilateral PA revealed significant miscalibration. Calibration-in-the-large for every model was >0 (range, 0.35–1.67), signifying systematic underprediction of lateralizing disease. Calibration slopes were consistently <1 (range, 0.35–0.87), indicating poor performance at the extremes of risk. CONCLUSIONS Overall, clinical prediction models did not accurately predict AVS lateralization in this large cohort. These models cannot be reliably used to inform the decision to pursue AVS for most patients.
Collapse
Affiliation(s)
- Davis Sam
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Gregory A Kline
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Benny So
- Department of Radiology, University of Calgary, Calgary, Alberta, Canada
| | | | - Janice L Pasieka
- Department of Surgery, University of Calgary, Calgary, Alberta, Canada
| | - Adrian Harvey
- Department of Surgery, University of Calgary, Calgary, Alberta, Canada
| | - Alex Chin
- Alberta Precision Laboratories, Alberta Health Services, Calgary, Alberta, Canada
- Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, Alberta, Canada
| | | | - Cori E Caughlin
- Department of Radiology, University of Calgary, Calgary, Alberta, Canada
| | - Alexander A Leung
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Correspondence: Alexander A. Leung ()
| |
Collapse
|
19
|
Teresa Fuss C, Brohm K, Fassnacht M, Kroiss M, Hahner S. Reassessment of Postural Stimulation Testing as a Simple Tool to Identify a Subgroup of Patients With Unilateral Primary Aldosteronism. J Clin Endocrinol Metab 2022; 107:e865-e873. [PMID: 34415988 PMCID: PMC8764226 DOI: 10.1210/clinem/dgab611] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Indexed: 11/19/2022]
Abstract
CONTEXT Adrenal vein sampling (AVS) represents the current diagnostic gold standard for differentiation between unilateral and bilateral primary aldosteronism (PA). Postural stimulation testing (PST) has been used to provide additional diagnostic information. OBJECTIVE This work aimed to evaluate the diagnostic utility of PST in the differential diagnosis of PA. METHODS This cohort study was conducted at a single tertiary reference center. We analyzed 106 PST performed between 2008 and 2020. Diagnosis of PA and cause of PA were determined according to the Endocrine Society Clinical Practice Guideline, taking into account results of saline infusion testing, AVS, preoperative imaging, and outcome after medical or surgical treatment. The suggested cutoffs for the diagnosis of unilateral PA were revisited and optimized for high specificity using receiver operating characteristics (ROC) analysis. RESULTS A total of 106 patients had confirmed PA (unilateral PA: n = 55, bilateral PA: n = 29, AVS unsuccessful/declined by patients: n = 22). Based on decreased aldosterone plasma concentration of 28% or more after 4 hours in the upright position, the PST showed a sensitivity of 36.4% at a specificity of 100% to identify unilateral disease (area under the curve [AUC] = 0.72; 95% CI, 0.62-0.83; P = .001). In patients with valid testing (drop of cortisol of 10% or more after 4 hours, n = 53) the sensitivity of PST rose to 51.4% at a specificity of 100% (AUC = 0.77; 95% CI, 0.65-0.90; P = .001). CONCLUSION The high specificity of 100% for the detection of unilateral PA in patients with decreased aldosterone by at least 28% after 4 hours makes PST a simple, noninvasive contribution to subtype differentiation in PA.
Collapse
Affiliation(s)
- Carmina Teresa Fuss
- Division of Endocrinology and Diabetes, Department of Internal Medicine I, University Hospital, University of Würzburg, Würzburg, Germany
- Correspondence: Carmina Teresa Fuss, MD, Department of Internal Medicine I, Division of Endocrinology and Diabetes, University Hospital Würzburg, University of Würzburg, Oberdürrbacher Strasse 6, 97080 Würzburg, Germany.
| | - Katharina Brohm
- Division of Endocrinology and Diabetes, Department of Internal Medicine I, University Hospital, University of Würzburg, Würzburg, Germany
| | - Martin Fassnacht
- Division of Endocrinology and Diabetes, Department of Internal Medicine I, University Hospital, University of Würzburg, Würzburg, Germany
- Central Laboratory, Core Unit Clinical Mass Spectrometry, University Hospital Würzburg, Würzburg, Germany
| | - Matthias Kroiss
- Division of Endocrinology and Diabetes, Department of Internal Medicine I, University Hospital, University of Würzburg, Würzburg, Germany
- Central Laboratory, Core Unit Clinical Mass Spectrometry, University Hospital Würzburg, Würzburg, Germany
- LMU Klinikum, Department of Internal Medicine IV, Munich, Germany
| | - Stefanie Hahner
- Division of Endocrinology and Diabetes, Department of Internal Medicine I, University Hospital, University of Würzburg, Würzburg, Germany
| |
Collapse
|
20
|
Parasiliti-Caprino M, Bioletto F, Ceccato F, Lopez C, Bollati M, Di Carlo MC, Voltan G, Rossato D, Giraudo G, Scaroni C, Ghigo E, Maccario M. The Accuracy of Simple and Adjusted Aldosterone Indices for Assessing Selectivity and Lateralization of Adrenal Vein Sampling in the Diagnosis of Primary Aldosteronism Subtypes. Front Endocrinol (Lausanne) 2022; 13:801529. [PMID: 35250861 PMCID: PMC8888437 DOI: 10.3389/fendo.2022.801529] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 01/19/2022] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE This study aimed to evaluate the reliability of simple and corrected aldosterone indices for assessing the selectivity and lateralization of adrenal vein sampling (AVS) in patients with primary aldosteronism. METHODS Data of all consecutive patients with primary aldosteronism who underwent AVS for subtype diagnosis, followed at two Italian referral centers, were analyzed retrospectively. RESULTS AVS achieved bilateral selectivity in 112/144 patients. Unilateral disease was diagnosed in 60 cases (53.6%) and idiopathic hyperaldosteronism in 52 individuals (46.4%). The aldosterone index (aldosterone ratio between an adrenal vein and the inferior vena cava) showed a high accuracy in predicting selectivity, compared to a cortisol selectivity index of 1.1, and a moderate accuracy, compared to cortisol cut-offs of 2 and 3. The simple aldosterone index showed a moderate accuracy in predicting ipsi/contralateral aldosterone hypersecretion, while lesion side- and hypokalemia-corrected aldosterone index revealed a significant improvement in predicting ipsi/contralateral disease. Moreover, the comparative aldosterone index (aldosterone ratio in the dominant vs the non-dominant adrenal vein) revealed a high accuracy in predicting unilateral primary aldosteronism. For an immediate clinical application of our results, the adjusted cut-offs were calculated, according to the Youden's criterion and to a pre-established specificity of 90%, for all possible combinations of lesion side at imaging and presence/absence of hypokalemia. CONCLUSIONS This study demonstrated the diagnostic accuracy of simple and clinical-/imaging-corrected aldosterone indices for adrenal vein sampling in subtype diagnosis of primary aldosteronism and suggests the potential application of these tools to select patients for adrenalectomy when standard indices cannot be performed.
Collapse
Affiliation(s)
- Mirko Parasiliti-Caprino
- Endocrinology, Diabetes and Metabolism, Department of Medical Sciences, City of Health and Science University Hospital, University of Turin, Turin, Italy
- *Correspondence: Mirko Parasiliti-Caprino, ; orcid.org/0000-0002-6930-7073
| | - Fabio Bioletto
- Endocrinology, Diabetes and Metabolism, Department of Medical Sciences, City of Health and Science University Hospital, University of Turin, Turin, Italy
| | - Filippo Ceccato
- Endocrinology Unit, Department of Medicine DIMED, University-Hospital of Padua, Padua, Italy
| | - Chiara Lopez
- Endocrinology, Diabetes and Metabolism, Department of Medical Sciences, City of Health and Science University Hospital, University of Turin, Turin, Italy
| | - Martina Bollati
- Endocrinology, Diabetes and Metabolism, Department of Medical Sciences, City of Health and Science University Hospital, University of Turin, Turin, Italy
| | - Maria Chiara Di Carlo
- Endocrinology, Diabetes and Metabolism, Department of Medical Sciences, City of Health and Science University Hospital, University of Turin, Turin, Italy
| | - Giacomo Voltan
- Endocrinology Unit, Department of Medicine DIMED, University-Hospital of Padua, Padua, Italy
| | - Denis Rossato
- Radiology Unit, City of Health and Science University Hospital, University of Turin, Turin, Italy
| | - Giuseppe Giraudo
- Surgery, City of Health and Science University Hospital, University of Turin, Turin, Italy
| | - Carla Scaroni
- Endocrinology Unit, Department of Medicine DIMED, University-Hospital of Padua, Padua, Italy
| | - Ezio Ghigo
- Endocrinology, Diabetes and Metabolism, Department of Medical Sciences, City of Health and Science University Hospital, University of Turin, Turin, Italy
| | - Mauro Maccario
- Endocrinology, Diabetes and Metabolism, Department of Medical Sciences, City of Health and Science University Hospital, University of Turin, Turin, Italy
| |
Collapse
|
21
|
El-Asmar N, Rajpal A, Arafah BM. Primary Hyperaldosteronism: Approach to Diagnosis and Management. Med Clin North Am 2021; 105:1065-1080. [PMID: 34688415 DOI: 10.1016/j.mcna.2021.06.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Hyperaldosteronism is a relatively more common disorder than previously recognized. Patients with hyperaldosteronism are at high risk for cardiovascular events. Patients suspected of having hyperaldosteronism should undergo initial screening and subsequent confirmatory testing to establish a biochemical diagnosis. Although adrenal computed tomography/magnetic resonance imaging scans often define a disease's subtype, adrenal vein sampling, in order to determine lateralization, may be necessary in some patients who are surgical candidates. Medical therapy using optimal doses of mineralocorticoid receptor antagonists can control symptoms and normalize plasma renin activity. The long-term outcome of patients treated with either surgical or optimal medical therapy appears similar.
Collapse
Affiliation(s)
- Nadine El-Asmar
- Division of Clinical and Molecular Endocrinology, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Cleveland, OH 44106, USA; Case Western Reserve University, Cleveland, OH, USA
| | - Aman Rajpal
- Case Western Reserve University, Cleveland, OH, USA; Louis Stokes VA Medical Center, 10701 East Blvd, Cleveland OH 44106, USA
| | - Baha M Arafah
- Division of Clinical and Molecular Endocrinology, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Cleveland, OH 44106, USA; Case Western Reserve University, Cleveland, OH, USA.
| |
Collapse
|
22
|
Does Intraprocedural CT Improve the Success Rate of Adrenal Venous Sampling? A Systematic Review and Meta-Analysis of Data from 809 Patients. Cardiovasc Intervent Radiol 2021; 45:29-40. [PMID: 34518912 DOI: 10.1007/s00270-021-02954-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 08/22/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE To perform a systematic review and meta-analysis to quantify the technical success rate of adrenal venous sampling (AVS) with and without intraprocedural computed tomography (CT). METHODS A systematic search of the Medline, Scopus, EMBASE, and Web of Science databases for comparative studies using intraprocedural CT was undertaken. More than 1,000 records were screened using titles and abstracts. Full texts of 121 studies were reviewed and 14 eligible studies were identified. Nine studies had adequate comparative data and were included in the meta-analysis. RESULTS A research synthesis was performed and data from 809 patients were pooled in multiple random effect models. Overall success rate of AVS without and with intraprocedural CT was 72.7% (59.3-83.0%) and 92.5% (86.6-95.9), respectively. The addition of intraprocedural CT increased the technical success rate by 19.8% (P < 0.001), with an odds ratio (OR) of 5.5 (3.3-9.2; P < 0.01). In meta-regression, odds of success with intraprocedural CT was associated with younger age (beta: 0.16 ± 0.05; P:0.001), higher body mass index (BMI; beta:0.08 ± 0.03; P:0.002), and higher selectivity index (defined as the ratio of cortisol in the adrenal vein to that in the inferior vena cava; beta:0.35 ± 0.08, P < 0.001). We found a linear inverse association between operator's success without CT and improved success with intraprocedural CT (R2: 0.86). CONCLUSIONS Intraprocedural CT is not required for every case, but can be performed in difficult cases or when operators' success is limited. The benefit was more pronounced in younger patients with higher BMI, female gender, and with higher selectivity. LEVEL OF EVIDENCE III Systematic review and meta-analysis of non-randomized clinical trials.
Collapse
|
23
|
Sun F, Hong Y, Zhang H, Liu X, Zhao Z, He H, Yan Z, Zhu Z. Determination of adrenal hypersecretion in primary Aldosteronism without aldosterone-production adenomas. BMC Endocr Disord 2021; 21:114. [PMID: 34059026 PMCID: PMC8167985 DOI: 10.1186/s12902-021-00770-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Accepted: 05/16/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Primary aldosteronism (PA) is highly prevalent in hypertensive population. Adrenal vein sampling (AVS) is the only procedure to assess adrenal aldosterone hypersecretion in PA. PA patients without aldosterone-producing adenomas (APA) frequently have unilateral aldosterone hypersecretion (UAH). These patients could bear inappropriate adrenalectomy without AVS. This study aims to identify which clinical characteristics should be recommended to perform AVS in these PA patients. METHODS This study was performed from January 2018 to July 2019 at a center for hypertension and metabolic diseases. Adrenal computed tomography (CT) scan, biochemical evaluation, and AVS were performed. RESULTS Total 141 patients were included in this study. Aldosterone to renin ratio (ARR) after confirmatory test is highly associated with adrenal laterality. The specificity of ARR > 10 (ng/dL)/(mU/L) after confirmatory test is 100%. After confirmatory test, patients with ARR > 10 (ng/dL)/(mU/L) had higher plasma aldosterone concentration and incidences of ischemic heart diseases and renal damage(p < 0.05). CONCLUSIONS After confirmatory tests, ARR > 10 (ng/dL)/(mU/L) indicates adrenal laterality, with increasingly cardiorenal damage in PA patients without APA. Thus, AVS should be recommended in these patients before surgery. TRIAL REGISTRATION NCT03398785 , Date of Registration: December 24, 2017.
Collapse
Affiliation(s)
- Fang Sun
- Center for Hypertension and Metabolic Diseases, Department of Hypertension and Endocrinology, Daping Hospital, Army Medical University of PLA, Chongqing, 400042, China
| | - Yangning Hong
- Center for Hypertension and Metabolic Diseases, Department of Hypertension and Endocrinology, Daping Hospital, Army Medical University of PLA, Chongqing, 400042, China
| | - Hexuan Zhang
- Center for Hypertension and Metabolic Diseases, Department of Hypertension and Endocrinology, Daping Hospital, Army Medical University of PLA, Chongqing, 400042, China
| | - Xiaoli Liu
- Center for Hypertension and Metabolic Diseases, Department of Hypertension and Endocrinology, Daping Hospital, Army Medical University of PLA, Chongqing, 400042, China
| | - Zhigang Zhao
- Center for Hypertension and Metabolic Diseases, Department of Hypertension and Endocrinology, Daping Hospital, Army Medical University of PLA, Chongqing, 400042, China
| | - Hongbo He
- Center for Hypertension and Metabolic Diseases, Department of Hypertension and Endocrinology, Daping Hospital, Army Medical University of PLA, Chongqing, 400042, China
| | - Zhencheng Yan
- Center for Hypertension and Metabolic Diseases, Department of Hypertension and Endocrinology, Daping Hospital, Army Medical University of PLA, Chongqing, 400042, China
| | - Zhiming Zhu
- Center for Hypertension and Metabolic Diseases, Department of Hypertension and Endocrinology, Daping Hospital, Army Medical University of PLA, Chongqing, 400042, China.
| |
Collapse
|
24
|
Gkaniatsa E, Sakinis A, Palmér M, Muth A, Trimpou P, Ragnarsson O. Adrenal Venous Sampling in Young Patients with Primary Aldosteronism. Extravagance or Irreplaceable? J Clin Endocrinol Metab 2021; 106:e2087-e2095. [PMID: 33507307 DOI: 10.1210/clinem/dgab047] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Indexed: 11/19/2022]
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.
Collapse
Affiliation(s)
- Eleftheria Gkaniatsa
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine at Sahlgrenska Academy, University of Gothenburg, Sweden
- The Department of Endocrinology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Augustinas Sakinis
- Department of Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Magnus Palmér
- Department of Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Andreas Muth
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Penelope Trimpou
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine at Sahlgrenska Academy, University of Gothenburg, Sweden
- The Department of Endocrinology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Oskar Ragnarsson
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine at Sahlgrenska Academy, University of Gothenburg, Sweden
- The Department of Endocrinology, Sahlgrenska University Hospital, Gothenburg, Sweden
| |
Collapse
|
25
|
Lee SH, Kim JW, Yoon HK, Koh JM, Shin CS, Kim SW, Kim JH. Diagnostic Accuracy of Computed Tomography in Predicting Primary Aldosteronism Subtype According to Age. Endocrinol Metab (Seoul) 2021; 36:401-412. [PMID: 33789036 PMCID: PMC8090455 DOI: 10.3803/enm.2020.901] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 02/15/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Guidelines by the Endocrine Society Guideline on bypassing adrenal vein sampling (AVS) in patients <35 years old with marked primary aldosteronism (PA) (hypokalemia and elevated plasma aldosterone concentration [PAC]) and a unilateral lesion on computed tomography (CT) are based on limited number of studies. We aimed to determine the accuracy of CT in PA patients according to age. METHODS In this retrospective study, we investigated the concordance between CT and AVS in 466 PA patients from two tertiary centers who successfully underwent AVS. RESULTS CT had an overall accuracy of 64.4% (300/466). In the group with unilateral lesion, patients with hypokalemia had higher concordance than those without hypokalemia (85.0% vs. 43.6%, P<0.001). In the group with marked PA (hypokalemia and PAC >15.9 ng/dL) and unilateral lesion, accuracy of CT was 84.6% (11/13) in patients aged <35 years; 100.0% (20/20), aged 35 to 39 years; 89.4% (59/66), aged 40 to 49 years; and 79.8% (79/99), aged ≥50 years. Cut-off age and PAC for concordance was <50 years and >29.6 ng/dL, respectively. The significant difference in accuracy of CT in 198 patients with marked PA and a unilateral lesion between the <50-year age group and ≥50-year age group (90.9% vs. 79.8%, P=0.044) disappeared in 139 of 198 patients with PAC > 30.0 ng/dL (91.9% vs. 87.7%, P=0.590). CONCLUSION Patients with hypokalemia, PAC >30.0 ng/dL, and unilateral lesion were at high risk of unilateral PA regardless of age.
Collapse
Affiliation(s)
- Seung Hun Lee
- Division of Endocrinology and Metabolism, Department of Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul,
Korea
| | - Jong Woo Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul,
Korea
| | - Hyun-Ki Yoon
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul,
Korea
| | - Jung-Min Koh
- Division of Endocrinology and Metabolism, Department of Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul,
Korea
| | - Chan Soo Shin
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul,
Korea
| | - Sang Wan Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul,
Korea
- Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul,
Korea
| | - Jung Hee Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul,
Korea
| |
Collapse
|
26
|
Nakai K, Tsurutani Y, Inoue K, Matsui S, Makita K, Yamazaki Y, Sasano H, Makita N, Nangaku M, Saito J, Omura M, Nishikawa T. Steroidogenic Activity in Unresected Adrenals Associated With Surgical Outcomes in Primary Aldosteronism. Hypertension 2021; 77:1638-1646. [PMID: 33775128 DOI: 10.1161/hypertensionaha.120.16335] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
[Figure: see text].
Collapse
Affiliation(s)
- Kazuki Nakai
- Endocrinology and Diabetes Center (K.N., Y.T., K.I., J.S., T.N.), Yokohama Rosai Hospital, Japan.,Division of Nephrology and Endocrinology, The University of Tokyo Hospital, Japan (K.N., N.M., M.N.)
| | - Yuya Tsurutani
- Endocrinology and Diabetes Center (K.N., Y.T., K.I., J.S., T.N.), Yokohama Rosai Hospital, Japan
| | - Kosuke Inoue
- Endocrinology and Diabetes Center (K.N., Y.T., K.I., J.S., T.N.), Yokohama Rosai Hospital, Japan.,Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles (K.I.)
| | - Seishi Matsui
- Department of Radiology (S.M.), Yokohama Rosai Hospital, Japan
| | - Kohzoh Makita
- Department of Radiology, Nerima Hikarigaoka Hospital, Tokyo, Japan (K.M.)
| | - Yuto Yamazaki
- Department of Pathology, Tohoku University Graduate School of Medicine, Sendai, Japan (Y.Y., H.S.)
| | - Hironobu Sasano
- Department of Pathology, Tohoku University Graduate School of Medicine, Sendai, Japan (Y.Y., H.S.)
| | - Noriko Makita
- Division of Nephrology and Endocrinology, The University of Tokyo Hospital, Japan (K.N., N.M., M.N.)
| | - Masaomi Nangaku
- Division of Nephrology and Endocrinology, The University of Tokyo Hospital, Japan (K.N., N.M., M.N.)
| | - Jun Saito
- Endocrinology and Diabetes Center (K.N., Y.T., K.I., J.S., T.N.), Yokohama Rosai Hospital, Japan
| | - Masao Omura
- Minato Mirai Medical Square, Yokohama, Japan (M.O.)
| | - Tetsuo Nishikawa
- Endocrinology and Diabetes Center (K.N., Y.T., K.I., J.S., T.N.), Yokohama Rosai Hospital, Japan.,Nishikawa Clinic, Yokohama, Japan (T.N.)
| |
Collapse
|
27
|
Chen S, Liu H, Luo P, Yu Y. Computed tomography combined with confirmatory tests for the diagnosis of aldosterone-producing adenoma. Endocr J 2021; 68:299-306. [PMID: 33100281 DOI: 10.1507/endocrj.ej20-0395] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Primary aldosteronism (PA) is the most common cause of secondary hypertension, and a simpler non-invasive method for identification of aldosterone-producing adenoma (APA) is required to improve the standard of medical treatment for PA patients. We retrospectively analyzed the clinical data of hypertensive patients with an aldosterone/renin ratio (ARR) ≥30 (ng/dL)/(ng/mL/h), and surgical and/or adrenal venous sampling (AVS) results served as the gold standard for APA diagnosis. The study aimed to determine whether positive CCT and SIT results plus a unilateral adrenal nodule found by CT allow unambiguous identification of an APA with high diagnostic specificity. Clinical data from 71 APA and 47 non-APA patients were collected, and logistic regression analysis was performed to construct models. Receiver operating characteristic (ROC) curves were used to analyze the efficacy of diagnostic tests. The areas under the ROC curves (AUCs) were similar between the post-SIT plasma aldosterone concentration (PAC) and post-CCT PAC (p > 0.05). The optimal post-SIT and post-CCT PAC cutoff values were 17.2 and 21.2 ng/dL, respectively. Positive CT findings combined with a post-SIT PAC >17.2 ng/dL or post-CCT PAC >21.2 ng/dL provided specificities of 97.8% and 95.7% for predicting APA, respectively. Logistic diagnostic models 1 (M1, CT finding + post-SIT PAC) and 2 (M2, CT finding + post-CCT PAC) were built, which showed equivalent diagnostic value (AUC = 0.959 and 0.932, respectively) (p > 0.05). The models combining CT findings with post-SIT PACs or post-CCT PACs represent an easier method to distinguish APA patients from other hypertensive patients with positive upright ARR results, especially in primary care where AVS may be unavailable.
Collapse
Affiliation(s)
- Shihan Chen
- Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Hui Liu
- Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Panyu Luo
- Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Yerong Yu
- Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| |
Collapse
|
28
|
Jing Y, Liao K, Li R, Yang S, Song Y, He W, Wang K, Yang J, Li Q, Hu J. Cardiovascular events and all-cause mortality in surgically or medically treated primary aldosteronism: A Meta-analysis. J Renin Angiotensin Aldosterone Syst 2021; 22:14703203211003781. [PMID: 33752505 PMCID: PMC8880484 DOI: 10.1177/14703203211003781] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Objectives: To compare the effect of surgical or medical treatment on the risk of cardiovascular diseases (CVD) and all-cause mortality in patients with established primary aldosteronism (PA). Methods: We searched PUBMED, MEDLINE and Cochrane Library for the meta-analysis. We included patients who were diagnosed with PA following guideline-supported protocols and received surgery or mineralocorticoid receptor antagonist (MRA)-based medical treatment, and age-sex matched patients with treated essential hypertension (EH). Primary endpoints were CVD incidence and all-cause mortality. Results: Compared with EH, patients with treated PA had a higher risk of CVD [odds ratio (OR) 1.79; 95% confidence interval (CI) 1.39–2.31]. This elevated risk was only observed in patients with medically treated PA [OR 2.11; 95%CI 1.88–2.38] but not in those with surgically treated PA. The risk of all-cause mortality was significantly lower in patients with treated PA [OR 0.86; 95% CI 0.77–0.95] compared to EH. The reduced risk was only observed in patients with surgically treated PA [OR 0.47; 95% CI 0.34–0.66], but not in those with medically treated PA. Conclusions: Patients with medically treated PA have a higher risk of CVD compared to patients with EH. Surgical treatment of PA reduces the risk of CVD and all-cause mortality in patients with PA.
Collapse
Affiliation(s)
- Ying Jing
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Kangla Liao
- Department of Cardiovascular, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Ruolin Li
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Shumin Yang
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Ying Song
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Wenwen He
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Kanran Wang
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jun Yang
- Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Clayton, VIC, Australia.,Department of Medicine, Monash University, Clayton, VIC, Australia
| | - Qifu Li
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jinbo Hu
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| |
Collapse
|
29
|
Sam D, Kline GA, So B, Pasieka JL, Harvey A, Chin A, Przybojewski SJ, Leung AA. Surgical Outcomes Among Primary Aldosteronism Patients Without Visible Adrenal Lesions. J Clin Endocrinol Metab 2021; 106:e824-e835. [PMID: 33180934 PMCID: PMC7823310 DOI: 10.1210/clinem/dgaa821] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Indexed: 12/13/2022]
Abstract
CONTEXT Many patients with unilateral primary aldosteronism (PA) have normal adrenal imaging, but little is known about their outcome following adrenalectomy. OBJECTIVE To evaluate biochemical and clinical outcomes after adrenalectomy in patients with unilateral PA and normal-appearing adrenal imaging. DESIGN Retrospective cohort study of patients seen between January 2006 and May 2018. SETTING A Canadian tertiary care PA referral center. PATIENTS Consecutive individuals with PA, normal cross-sectional adrenal imaging, and lateralizing adrenal vein sampling (AVS) who underwent adrenalectomy during the study period. PRIMARY OUTCOME Biochemical response to adrenalectomy graded according to the Primary Aldosteronism Surgical Outcome criteria. RESULTS A total of 40 patients were included. Biochemical outcomes were available for 33 people (mean age, 54.7 years; 91% male; median follow-up, 2.7 months), with 28 (85%) showing a complete or partial response and 5 (15%) with no response. Clinical outcomes were available for 36 people (mean age, 54.6 years; 86% male; median follow-up, 9.8 months), with 31 (86%) demonstrating a complete or partial response and 5 (14%) with no response. CONCLUSIONS The prognosis after adrenalectomy is highly favorable for patients with unilateral PA and normal-appearing adrenal imaging. Patients with lateralizing disease should be considered for surgery despite apparently normal adrenal imaging.
Collapse
Affiliation(s)
- Davis Sam
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Gregory A Kline
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Benny So
- Department of Radiology, University of Calgary, Calgary, Alberta, Canada
| | - Janice L Pasieka
- Department of Surgery, University of Calgary, Calgary, Alberta, Canada
| | - Adrian Harvey
- Department of Surgery, University of Calgary, Calgary, Alberta, Canada
| | - Alex Chin
- Alberta Precision Laboratories, Alberta Health Services, Calgary, Alberta, Canada
- Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, Alberta, Canada
| | | | - Alexander A Leung
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Correspondence and Reprint Requests: Alexander A. Leung, MD, MPH, 1820 Richmond Road SW, Calgary, Alberta, T2T 5C7, Canada. E-mail:
| |
Collapse
|
30
|
Meng X, Yang YK, Li YH, Fan P, Zhang Y, Yang KQ, Wu HY, Jiang XJ, Cai J, Zhou XL. Clinical characteristics of concurrent primary aldosteronism and renal artery stenosis: A retrospective case-control study. Clin Exp Hypertens 2021; 43:7-12. [PMID: 32635757 DOI: 10.1080/10641963.2020.1790586] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Background: Rare cases of concurrent primary aldosteronism (PA) and renal artery stenosis (RAS) have been reported. Methods: In this retrospective case-control study, we selected a cohort of 10 PA with RAS patients and a control group of 20 PA without RAS patients from January 1, 2006, to January 1, 2016. Results: All patients presented with refractory hypertension, and a nonstatistically significant trend toward lower mean serum potassium was seen in the PA with RAS group (p =.07). PA with RAS patients had lower mean orthostatic aldosterone-to-renin ratios (38.4 ± 41.4 ng dL-1/ng mL-1 h-1 vs. 87.4.4 ± 38.4 ng dL-1/ng mL-1 h-1, respectively; p < .01) and a higher false-negative rate (50% vs. 15%, respectively; p < .05) compared with controls. All misdiagnosed patients had the diagnosis of PA confirmed when we revaluated the repeated screening and confirmative tests because of residual hypertension or hypokalemia after successful revascularization of renal artery stenosis. Conclusions: PA is easily missed in patients with RAS because of the high false-negative rate for screening tests. RAS patients with residual hypertension after successful renal angioplasty should be monitored for coexisting PA. Reevaluation of screening and confirmatory tests is helpful in establishing the correct diagnoses.
Collapse
Affiliation(s)
- Xu Meng
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College , Beijing, China
| | - Yan-Kun Yang
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College , Beijing, China
| | - Yue-Hua Li
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College , Beijing, China
| | - Peng Fan
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College , Beijing, China
| | - Ying Zhang
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College , Beijing, China
| | - Kun-Qi Yang
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College , Beijing, China
| | - Hai-Ying Wu
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College , Beijing, China
| | - Xiong-Jing Jiang
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College , Beijing, China
| | - Jun Cai
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College , Beijing, China
| | - Xian-Liang Zhou
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College , Beijing, China
| |
Collapse
|
31
|
St-Jean M, Bourdeau I, Martin M, Lacroix A. Aldosterone is Aberrantly Regulated by Various Stimuli in a High Proportion of Patients with Primary Aldosteronism. J Clin Endocrinol Metab 2021; 106:e45-e60. [PMID: 33000146 PMCID: PMC7765652 DOI: 10.1210/clinem/dgaa703] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Accepted: 09/28/2020] [Indexed: 11/19/2022]
Abstract
CONTEXT In primary aldosteronism (PA), aldosterone secretion is relatively independent of the renin-angiotensin system, but can be regulated by several other stimuli. OBJECTIVE To evaluate aldosterone response to several stimuli in a series of patients with PA secondary either to bilateral adrenal hyperplasia (BAH) or unilateral aldosterone-producing adenoma (APA). DESIGN AND SETTING Prospective cohort study conducted in a university teaching hospital research center. PATIENTS Forty-three patients with confirmed PA and subtyped by adrenal vein sampling (n = 39) were studied, including 11 with BAH, 28 with APA, and 4 with undefined etiology. We also studied 4 other patients with aldosterone and cortisol cosecretion. INTERVENTIONS We systematically explored aberrant regulation of aldosterone using an in vivo protocol that included the following stimulation tests performed over 3 days under dexamethasone suppression: upright posture, mixed meal, adrenocorticotropin (ACTH) 1-24, gonadotropin-releasing hormone (GnRH), vasopressin, and serotonin R4 agonist. MAIN OUTCOME MEASURES Positive response was defined as >50% renin or ACTH-independent increase in plasma aldosterone/cortisol concentration following the various stimulation tests. RESULTS Renin-independent aldosterone secretion increased in response to several aberrant stimuli (upright posture, GnRH) in up to 83% of patients with APA or BAH in whom ACTH 1-24 and HT4R agonists also produced aldosterone oversecretion in all patients. The mean significant aberrant responses per patient was similar in BAH (4.6) and in APA (4.0). CONCLUSIONS Aldosterone secretion in PA is relatively autonomous from the renin-angiotensin system, but is highly regulated by several other stimuli, which contributes to the large variability of aldosterone levels in PA patients.
Collapse
Affiliation(s)
- Matthieu St-Jean
- Division of Endocrinology, Department of Medicine and Research Center, Centre hospitalier de l’Université de Montréal (CHUM), Montréal, Québec, Canada
| | - Isabelle Bourdeau
- Division of Endocrinology, Department of Medicine and Research Center, Centre hospitalier de l’Université de Montréal (CHUM), Montréal, Québec, Canada
| | - Marc Martin
- Department of biochemistry, Clinical Department of Laboratory Medecine, Centre hospitalier de l’Université de Montréal (CHUM), Montréal, Québec, Canada
| | - André Lacroix
- Division of Endocrinology, Department of Medicine and Research Center, Centre hospitalier de l’Université de Montréal (CHUM), Montréal, Québec, Canada
| |
Collapse
|
32
|
Zhou Y, Wang D, Jiang L, Ran F, Chen S, Zhou P, Wang P. Diagnostic accuracy of adrenal imaging for subtype diagnosis in primary aldosteronism: systematic review and meta-analysis. BMJ Open 2020; 10:e038489. [PMID: 33384386 PMCID: PMC7780716 DOI: 10.1136/bmjopen-2020-038489] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVES Accurate subtype classification in primary aldosteronism (PA) is critical in assessing the optimal treatment options. This study aimed to evaluate the diagnostic accuracy of adrenal imaging for unilateral PA classification. METHODS Systematic searches of PubMed, EMBASE and the Cochrane databases were performed from 1 January 2000 to 1 February 2020, for all studies that used CT or MRI in determining unilateral PA and validated the results against invasive adrenal vein sampling (AVS). Summary diagnostic accuracies were assessed using a bivariate random-effects model. Subgroup analyses, meta-regression and sensitivity analysis were performed to explore the possible sources of heterogeneity. RESULT A total of 25 studies, involving a total of 4669 subjects, were identified. The overall analysis revealed a pooled sensitivity of 68% (95% CI: 61% to 74%) and specificity of 57% (95% CI 50% to 65%) for CT/MRI in identifying unilateral PA. Sensitivity was higher in the contrast-enhanced (CT) group versus the traditional CT group (77% (95% CI 66% to 85%) vs 58% (95% CI 50% to 66%). Subgroup analysis stratified by screening test for PA showed that the sensitivity of the aldosterone-to-renin ratio (ARR) group was higher than that of the non-ARR group (78% (95% CI 69% to 84%) vs 66% (95% CI 58% to 72%)). The diagnostic accuracy of PA patients aged ≤40 years was reported in four studies, and the overall sensitivity was 71%, with 79% specificity. Meta-regression revealed a significant impact of sample size on sensitivity and of age and study quality on specificity. CONCLUSION CT/MRI is not a reliable alternative to invasive AVS without excellent sensitivity or specificity for correctly identifying unilateral PA. Even in young patients (≤40 years), 21% of patients would have undergone unnecessary adrenalectomy based on imaging results alone.
Collapse
Affiliation(s)
- Yaqiong Zhou
- Cardiology, Clinical Medical College and The First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan, China
| | - Dan Wang
- Cardiology, Clinical Medical College and The First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan, China
| | - Licheng Jiang
- Cardiology, Clinical Medical College and The First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan, China
| | - Fei Ran
- Cardiology, Clinical Medical College and The First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan, China
| | - Sichao Chen
- Cardiology, Clinical Medical College and The First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan, China
| | - Peng Zhou
- Cardiology, Clinical Medical College and The First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan, China
| | - Peijian Wang
- Cardiology, Clinical Medical College and The First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan, China
| |
Collapse
|
33
|
Stavropoulos K, Imprialos K, Papademetriou V, Faselis C, Tsioufis K, Dimitriadis K, Doumas M. Primary Aldosteronism: Novel Insights. Curr Hypertens Rev 2020; 16:19-23. [PMID: 30987572 DOI: 10.2174/1573402115666190415155512] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 03/26/2019] [Accepted: 04/01/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Primary aldosteronism is one of the most common causes of secondary hypertension. Patients with this endocrine syndrome are at increased cardiovascular risk, higher than hypertensive individuals with equal blood pressure levels. OBJECTIVES The study aimed to thoroughly present and critically discuss the novel insights into the field of primary aldosteronism, focusing on the clinically meaningful aspects. METHOD We meticulously evaluated existing data in the field of primary aldosteronism in order to summarize future perspectives in this narrative review. RESULTS Novel data suggests that a subclinical form of primary aldosteronism might exist. Interesting findings might simplify the diagnostic procedure of the disease, especially for the localization of primary aldosteronism. The most promising progress has been noted in the field of the molecular basis of the disease, suggesting new potential therapeutic targets. CONCLUSION Several significant aspects are at early stages of evaluation. Future research is essential to investigate these well-promising perspectives.
Collapse
Affiliation(s)
| | - Konstantinos Imprialos
- 2nd Propedeutic Department of Internal Medicine, Aristotle University, Thessaloniki, Greece
| | | | - Charles Faselis
- VAMC and George Washington University, Washington, DC, United States
| | - Kostas Tsioufis
- 1st Cardiology Department, Kapodestrian University of Athens, Athens, Greece
| | | | - Michael Doumas
- 2nd Propedeutic Department of Internal Medicine, Aristotle University, Thessaloniki, Greece.,VAMC and George Washington University, Washington, DC, United States
| |
Collapse
|
34
|
Parasiliti-Caprino M, Bioletto F, Ceccato F, Lopez C, Bollati M, Voltan G, Rossato D, Giraudo G, Scaroni C, Ghigo E, Maccario M. The diagnostic accuracy of adjusted unconventional indices for adrenal vein sampling in the diagnosis of primary aldosteronism subtypes. J Hypertens 2020; 39:1025-1033. [PMID: 33186324 DOI: 10.1097/hjh.0000000000002700] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Simple unconventional indices did not demonstrate a satisfactory accuracy for diagnosing unilateral primary aldosteronism when adrenal vein sampling is not bilaterally selective. This study aimed to evaluate the reliability of clinical/imaging-corrected unconventional indices for adrenal vein sampling in predicting unilateral primary aldosteronism. METHODS Data of all consecutive patients with primary aldosteronism subtyped with adrenal vein sampling, referred to two Italian centers, were analyzed retrospectively. All patients with proved unilateral aldosterone hypersecretion underwent adrenalectomy. RESULTS Unilateral disease was diagnosed in 58 cases (54.2%) and idiopathic hyperaldosteronism in 49 individuals (45.8%). The monoadrenal index (aldosterone-to-cortisol ratio in the adrenal vein) showed high accuracy in predicting ipsilateral disease and moderate accuracy in predicting contralateral aldosterone hypersecretion. The monolateral index (aldosterone-to-cortisol ratio in the adrenal vein vs. peripheral blood) revealed moderate accuracy in predicting ipsilateral disease and high accuracy in predicting contralateral aldosterone hypersecretion. Lesion side- and hypokalemia-corrected ROC curves for these unconventional indices revealed a significant improvement in the reliability of predicting ipsilateral/contralateral disease, reaching high accuracy in all models. For an immediate clinical application of our results, the adjusted cut-offs were calculated, according to the Youden's criterion and to a pre-established specificity of 95%, for all possible combinations of lesion side at imaging and presence/absence of hypokalemia. CONCLUSION This study demonstrated the high diagnostic accuracy of clinical-/imaging-corrected unconventional indices for adrenal vein sampling in the diagnosis of primary aldosteronism subtypes and suggests the use of these adjusted indices to select patients for adrenalectomy when adrenal vein sampling is not bilaterally selective.
Collapse
Affiliation(s)
- Mirko Parasiliti-Caprino
- Endocrinology, Diabetes and Metabolism, City of Health and Science University Hospital, Department of Medical Sciences, University of Turin, Turin
| | - Fabio Bioletto
- Endocrinology, Diabetes and Metabolism, City of Health and Science University Hospital, Department of Medical Sciences, University of Turin, Turin
| | - Filippo Ceccato
- Endocrinology Unit, Department of Medicine DIMED, University-Hospital of Padua, Padua
| | - Chiara Lopez
- Endocrinology, Diabetes and Metabolism, City of Health and Science University Hospital, Department of Medical Sciences, University of Turin, Turin
| | - Martina Bollati
- Endocrinology, Diabetes and Metabolism, City of Health and Science University Hospital, Department of Medical Sciences, University of Turin, Turin
| | - Giacomo Voltan
- Endocrinology Unit, Department of Medicine DIMED, University-Hospital of Padua, Padua
| | | | - Giuseppe Giraudo
- Surgery, City of Health and Science University Hospital, University of Turin, Turin, Italy
| | - Carla Scaroni
- Endocrinology Unit, Department of Medicine DIMED, University-Hospital of Padua, Padua
| | - Ezio Ghigo
- Endocrinology, Diabetes and Metabolism, City of Health and Science University Hospital, Department of Medical Sciences, University of Turin, Turin
| | - Mauro Maccario
- Endocrinology, Diabetes and Metabolism, City of Health and Science University Hospital, Department of Medical Sciences, University of Turin, Turin
| |
Collapse
|
35
|
Abstract
Primary aldosteronism remains a leading cause of secondary hypertension, and its diagnosis and management continue to pose a challenge for clinicians. In this article, we review the diagnosis of primary aldosteronism along with its cardiovascular manifestations. Treatment is described depending on the diagnostic outcome, focusing on medical management with mineralocorticoid receptor antagonists and unilateral adrenalectomy. Although screening and diagnosing hyperaldosteronism follows well-known algorithms, in practice, physicians may find difficulty establishing the best course of action due to complexity in testing and confirming laterality of aldosterone production by the adrenals. Recognizing and treating primary aldosteronism requires a multidisciplinary approach with primary care physicians, cardiologists, endocrinologists, and radiologists working collaboratively.
Collapse
|
36
|
Adrenal vein sampling for primary aldosteronism: a 15-year national referral center experience. Radiol Oncol 2020; 54:409-418. [PMID: 32889797 PMCID: PMC7585337 DOI: 10.2478/raon-2020-0052] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 07/12/2020] [Indexed: 12/11/2022] Open
Abstract
Background Adrenal vein sampling (AVS) is essential for diagnostics of primary aldosteronism, distinguishing unilateral from bilateral disease and determining treatment options. We reviewed the performance of AVS for primary aldosteronism at our center during first 15 years, comparing the initial period to the period after the introduction of a dedicated radiologist. Additionally, AVS outcomes were checked against CT findings and the proportion of operated patients with proven unilateral disease was estimated. Patients and methods A retrospective cross-sectional study conducted at the national endocrine referral center included all patients with primary aldosteronism who underwent AVS after its introduction in 2004 until the end of 2018. AVS was performed sequentially during Synacthen infusion. When the ratio of cortisol concentrations from adrenal vein and inferior vena cava was at least 5, AVS was considered successful. Results Data from 235 patients were examined (168 men; age 32–73, median 56 years; BMI 18–48, median 30.4 kg/ m2). Average number of annual AVS procedures increased from 7 in the 2004–2011 period to 29 in the 2012–2018 period (p < 0.001). AVS had to be repeated in 10% of procedures; it was successful in 77% of procedures and 86% of patients. The proportion of patients with successful AVS (92% in 2012–2018 vs. 66% in 2004–2011, p < 0.001) and of successful AVS procedures (82% vs. 61%, p < 0.001) was statistically significantly higher in the recent period. Conclusions Number of AVS procedures and success rate at our center increased over time. Introduction of a dedicated radiologist and technical advance expanded and improved the AVS practice.
Collapse
|
37
|
Sam D, Kline GA, So B, Przybojewski SJ, Leung AA. Unilateral Disease Is Common in Patients With Primary Aldosteronism Without Adrenal Nodules. Can J Cardiol 2020; 37:269-275. [PMID: 32428615 DOI: 10.1016/j.cjca.2020.05.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 04/21/2020] [Accepted: 05/09/2020] [Indexed: 10/24/2022] Open
Abstract
BACKGROUND Patients with primary aldosteronism (PA) without apparent adrenal nodularity have not been well characterised in the literature. The aim of this study was to assess for unilateral aldosterone hypersecretion among patients with primary aldosteronism with normal-appearing adrenals using adrenal vein sampling (AVS). METHODS In this cross-sectional study performed at a Canadian tertiary care centre, we reviewed all consecutive PA patients lacking a definitive adrenal nodule who were referred for AVS in the work-up of PA between January 2006 and May 2018. AVS indications included an elevated aldosterone-to-renin ratio and high-probability features of PA. RESULTS In total, 174 patients were included (mean age, 52.0 years; 62.6% male), and 70 (40.2%) had unilateral aldosterone hypersecretion. There was a positive linear association between higher age categories (by decade) and lateralisation (P = 0.03). For every decade of age, there was a 30% higher odds of lateralisation (odds ratio, 1.03 per year; 95% confidence interval, 1.00-1.05). The frequency of lateralisation was higher in males compared with females (47.7% vs 27.7%), with a 2-fold greater odds of unilateral disease (odds ratio, 2.38; 95% confidence interval, 1.23-4.61). Traditional biomarkers of lateralisation among patients with adrenal nodules (eg, serum potassium and aldosterone-to-renin ratio levels) were not predictive of lateralisation in this population. CONCLUSIONS Many patients with PA who lack definitive adrenal nodules have lateralising disease. Efforts to optimise referrals for AVS may be prioritised by focusing on patients most likely to have unilateral disease, especially males and older adults.
Collapse
Affiliation(s)
- Davis Sam
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Gregory A Kline
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Benny So
- Department of Radiology, University of Calgary, Calgary, Alberta, Canada
| | | | - Alexander A Leung
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.
| |
Collapse
|
38
|
Nagano H, Kono T, Saiga A, Kubota Y, Fujimoto M, Felizola SJA, Ishiwata K, Tamura A, Higuchi S, Sakuma I, Hashimoto N, Suzuki S, Koide H, Takeshita N, Sakamoto S, Ban T, Yokote K, Nakamura Y, Ichikawa T, Uno T, Tanaka T. Aldosterone Reduction Rate After Saline Infusion Test May Be a Novel Prediction in Patients With Primary Aldosteronism. J Clin Endocrinol Metab 2020; 105:5599822. [PMID: 31628466 DOI: 10.1210/clinem/dgz092] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 09/17/2019] [Accepted: 10/01/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Accurate assessment and localization of aldosterone-producing adenomas (APAs) are essential for the treatment of primary aldosteronism (PA). Although adrenal venous sampling (AVS) is the standard method of reference for subtype diagnosis in PA, controversy exists concerning the criteria for its interpretation. This study aims to determine better indicators that can reliably predict subtypes of PA. METHOD Retrospective, single-cohort analysis including 209 patients with PA who were subjected to AVS. Eighty-two patients whose plasma aldosterone concentrations (PAC) were normalized after surgery were histopathologically or genetically diagnosed with APA. The accuracy of image findings was compared to AVS results. Receiver operating characteristic (ROC) curve analysis between the operated and the no-apparent laterality groups was performed using AVS parameters and loading test for diagnosis of PA. RESULT Agreement between image findings and AVS results was 56.3%. ROC curve analysis revealed that the lateralization index (LI) after adrenocorticotropin stimulation cutoff was 2.40, with 98.8% sensitivity and 97.1% specificity. The contralateral suppression index (CSI) cutoff value was 1.19, with 98.0% sensitivity and 93.9% specificity. All patients over the LI and CSI cutoff values exhibited unilateral subtypes. Among the loading test, the best classification accuracy was achieved using the PAC reduction rate after a saline infusion test (SIT) >33.8%, which yielded 87.2% sensitivity or a PAC after a SIT <87.9 pg/mL with 86.2% specificity for predicting bilateral PA. CONCLUSION The combined criteria of the PAC reduction rate and PAC after the SIT can determine which subset of patients with APA who should be performed AVS for validation.
Collapse
Affiliation(s)
- Hidekazu Nagano
- Department of Molecular Diagnosis, Graduate School of Medicine, Chiba University, Chiba, Japan
- Division of Diabetes, Endocrinology and Metabolism, Chiba University Hospital, Chiba, Japan
| | - Takashi Kono
- Division of Diabetes, Endocrinology and Metabolism, Chiba University Hospital, Chiba, Japan
- Department of Endocrinology, Hematology and Gerontology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Atsushi Saiga
- Department of Radiology, Chiba University Hospital, Chiba, Japan
| | - Yoshihiro Kubota
- Department of Radiology, Chiba University Hospital, Chiba, Japan
| | - Masanori Fujimoto
- Division of Diabetes, Endocrinology and Metabolism, Chiba University Hospital, Chiba, Japan
- Department of Endocrinology, Hematology and Gerontology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Saulo J A Felizola
- Department of Molecular Diagnosis, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Kazuki Ishiwata
- Division of Diabetes, Endocrinology and Metabolism, Chiba University Hospital, Chiba, Japan
- Department of Endocrinology, Hematology and Gerontology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Ai Tamura
- Division of Diabetes, Endocrinology and Metabolism, Chiba University Hospital, Chiba, Japan
- Department of Endocrinology, Hematology and Gerontology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Seiichiro Higuchi
- Department of Molecular Diagnosis, Graduate School of Medicine, Chiba University, Chiba, Japan
- Department of Internal Medicine, Isumi Medical Center, Chiba, Japan
| | - Ikki Sakuma
- Division of Diabetes, Endocrinology and Metabolism, Chiba University Hospital, Chiba, Japan
- Department of Endocrinology, Hematology and Gerontology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Naoko Hashimoto
- Department of Molecular Diagnosis, Graduate School of Medicine, Chiba University, Chiba, Japan
- Division of Diabetes, Endocrinology and Metabolism, Chiba University Hospital, Chiba, Japan
| | - Sawako Suzuki
- Division of Diabetes, Endocrinology and Metabolism, Chiba University Hospital, Chiba, Japan
- Department of Endocrinology, Hematology and Gerontology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Hisashi Koide
- Division of Diabetes, Endocrinology and Metabolism, Chiba University Hospital, Chiba, Japan
- Department of Endocrinology, Hematology and Gerontology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | | | | | - Toshiaki Ban
- Department of Internal Medicine, Isumi Medical Center, Chiba, Japan
| | - Koutaro Yokote
- Division of Diabetes, Endocrinology and Metabolism, Chiba University Hospital, Chiba, Japan
- Department of Endocrinology, Hematology and Gerontology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Yasuhiro Nakamura
- Division of Pathology, Tohoku Medical and Pharmaceutical University, Miyagi, Japan
| | | | - Takashi Uno
- Department of Radiology, Chiba University Hospital, Chiba, Japan
| | - Tomoaki Tanaka
- Department of Molecular Diagnosis, Graduate School of Medicine, Chiba University, Chiba, Japan
- Division of Diabetes, Endocrinology and Metabolism, Chiba University Hospital, Chiba, Japan
| |
Collapse
|
39
|
Shifman BM, Platonova NM, Molashenko NV, Troshina EA, Sitkin II, Belcevich DG, Kovalevich LD, Romanova NY, Kolesnikova GS. [Primary hyperaldosteronism: difficulties in diagnosis]. TERAPEVT ARKH 2019; 91:91-99. [PMID: 32598637 DOI: 10.26442/00403660.2019.10.000138] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Indexed: 11/22/2022]
Abstract
Primary hyperaldosteronism (PA) - is the clinical syndrome, results from autonomous of the major regulators of secretion, aldosterone overproduction by a tumorous or hyperplastic tissue in adrenal cortex. Being the most frequent cause of secondary hypertension, PA may be represented by disorders with unilateral or bilateral aldosterone overproduction and differential diagnosis between them is crucial for choosing a right therapeutic approache: lifelong medical therapy with mineralocorticoid receptor antagonists or unilateral adrenalectomy. Adrenal venous sampling (AVS) is currently the «gold standard» test for identifying laterality of excess hormone production, unlike imaging tests, sensitivity and specificity of which is not enough, due to inability to evaluate functional activity with confidence, and also to limitations in detecting tiny abnormalities of adrenals, such as microadenoma or hyperplasia. Excluding certain cases, AVS is recommended to patients with confirmed PA, planning surgical treatment, to determine the lateralization of aldosterone hypersecretion. Described clinical case of patient with confirmed lateralization from adrenal without any detected lesions on CT-imaging and nonfunctioning tumour on contralateral side, highlights the importance of using AVS for decision to refer patients for surgery.
Collapse
|
40
|
|
41
|
Sam D, Kline GA, So B, Leung AA. Discordance Between Imaging and Adrenal Vein Sampling in Primary Aldosteronism Irrespective of Interpretation Criteria. J Clin Endocrinol Metab 2019; 104:1900-1906. [PMID: 30590677 DOI: 10.1210/jc.2018-02089] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 12/19/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND Subtyping of primary aldosteronism (PA) using imaging and adrenal vein sampling (AVS) may yield discordant results, causing confusion in management. Interpretation criteria for AVS lateralization may affect discordance rates. METHODS We identified consecutive patients with PA who underwent AVS at a quaternary care center between January 2006 and May 2018. Patient demographics, laboratory results, diagnostic imaging, and AVS results were retrieved. Adrenal cross-sectional imaging was compared with AVS findings. The presence of lateralization was defined using varying thresholds for the lateralization index (LI) from >2:1 to >5:1. Discordance was defined by a unilateral lesion on imaging with contralateral or nonlateralization on AVS. RESULTS A total of 342 patients were included; 68.7% had hypokalemia. With cross-sectional imaging, 191 (55.6%) patients had unilateral lesions, 47 (13.7%) had bilateral lesions, and 104 (30.4%) had normal imaging. Overall discordance rates were high, ranging from 22% to 28% for LI thresholds of >2:1 and >5:1, respectively. Discordance between imaging and AVS was positively correlated with LI threshold stringency (P < 0.001). Patients with normal or bilateral lesions on imaging frequently lateralized on AVS. Lateralization, when present, was approximately equal between left and right sides, irrespective of the LI threshold. CONCLUSIONS Discrepancies between imaging and AVS were common, even among patients with nonspecific imaging. Discordance was greatest with the strictest AVS interpretation criteria. Even under the most lenient thresholds, apparent discordance between imaging and AVS exceeded 20% and may limit the ability to make surgical decisions. Reliance on imaging alone for detecting lateralization may be misleading.
Collapse
Affiliation(s)
- Davis Sam
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Gregory A Kline
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Benny So
- Department of Radiology, University of Calgary, Calgary, Alberta, Canada
| | - Alexander A Leung
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| |
Collapse
|
42
|
Wada N, Shibayama Y, Yoneda T, Katabami T, Kurihara I, Tsuiki M, Ichijo T, Ogawa Y, Kawashima J, Sone M, Yoshimoto T, Matsuda Y, Fujita M, Kobayashi H, Tamura K, Kamemura K, Otsuki M, Okamura S, Naruse M. Lateralizing Asymmetry of Adrenal Imaging and Adrenal Vein Sampling in Patients With Primary Aldosteronism. J Endocr Soc 2019; 3:1393-1402. [PMID: 31286105 PMCID: PMC6608550 DOI: 10.1210/js.2019-00131] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 05/10/2019] [Indexed: 01/09/2023] Open
Abstract
Context In patients with primary aldosteronism (PA), it remains unclear whether aldosterone-producing adenomas are likely to develop in the left or right adrenal gland. Objective To investigate left-right differences of PA laterality diagnoses via CT imaging and adrenal vein sampling (AVS). Design Retrospective, observational study. Patients From the Japan Primary Aldosteronism Study, 1493 patients with PA were enrolled who underwent CT and ACTH-stimulated AVS. Measurements Left or right adrenal nodular lesion distribution and laterality observed on CT scans and from AVS were noted. Results Both on CT scans and AVS, unilateral results were observed more frequently on the left side than on the right side (25.1% vs 15.4% and 17.3% vs 13.5%, respectively; P < 0.01for both diagnostic techniques). There was no significant difference in the concordance rate for CT and AVS between patients with left and right unilateral nodular lesions observed on CT scans (44.1% and 50.9%, respectively; P = 0.15). In patients with nodules <20 mm, the concordance rate was significantly greater on the right side than the left side (45.8% vs 56.4%; P = 0.03). In patients with bilateral results of AVS, unilateral nodular lesions were detected more frequently on the left side than the right side (17.8% vs 9.4%; P < 0.01). Conclusion These results suggest aldosterone-producing adenomas and nonfunctioning tumors are more likely to develop on the left side in patients with PA and that misdiagnosis of CT-based lateralization may occur more frequently on the left side.
Collapse
Affiliation(s)
- Norio Wada
- Department of Diabetes and Endocrinology, Sapporo City General Hospital, Sapporo, Japan
| | - Yui Shibayama
- Department of Diabetes and Endocrinology, Sapporo City General Hospital, Sapporo, Japan.,Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Takashi Yoneda
- Department of Health Promotion and Medicine of the Future, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Takuyuki Katabami
- Division of Metabolism and Endocrinology, Department of Internal Medicine, St Marianna University School of Medicine Yokohama City Seibu Hospital, Yokohama, Japan
| | - Isao Kurihara
- Division of Endocrinology, Metabolism and Nephrology, Keio University School of Medicine, Tokyo, Japan
| | - Mika Tsuiki
- Metabolism and Hypertension, Clinical Research Institute, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Takamasa Ichijo
- Department of Diabetes and Endocrinology, Saiseikai Yokohamashi Tobu Hospital, Yokohama, Japan
| | - Yoshihiro Ogawa
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Junji Kawashima
- Department of Metabolic Medicine, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Masakatsu Sone
- Department of Diabetes, Endocrinology and Nutrition, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Takanobu Yoshimoto
- Department of Molecular Endocrinology and Metabolism, Graduate School of Medicine, Tokyo Medical Dental University, Tokyo, Japan
| | - Yuichi Matsuda
- Department of Cardiology, Sanda City Hospital, Sanda, Japan
| | - Megumi Fujita
- Division of Nephrology and Endocrinology, The University of Tokyo, Tokyo, Japan
| | - Hiroki Kobayashi
- Division of Nephrology, Hypertension, and Endocrinology, Nihon University School of Medicine, Tokyo, Japan
| | - Kouichi Tamura
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | | | - Michio Otsuki
- Department of Metabolic Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | | | - Mitsuhide Naruse
- Metabolism and Hypertension, Clinical Research Institute, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | | |
Collapse
|
43
|
Wang D, Xu JZ, Chen X, Chen Y, Shao S, Zhang W, Zhu LM, Xu TY, Li Y, Wang JG. Speckle-Tracking Echocardiographic Layer-Specific Strain Analysis on Subclinical Left Ventricular Dysfunction in Patients With Primary Aldosteronism. Am J Hypertens 2019; 32:155-162. [PMID: 30462153 DOI: 10.1093/ajh/hpy175] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 11/20/2018] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Primary aldosteronism (PA) may cause myocardial injury. We investigated myocardial dysfunction using speckle-tracking echocardiographic (STE) layer-specific strain in patients with PA. METHODS Our study included 62 patients with PA (33 aldosterone-producing adenoma [APA] and 29 idiopathic hyperaldosteronism [IHA]) and 30 patients with primary hypertension. STE was acquired using the GE Vivid E9 equipment. The longitudinal (LS) and circumferential (CS) layer-specific strains of the endocardium, midmyocardium, and epicardium (LSendo, LSmid, LSepi, CSendo, CSmid, and CSepi) were obtained using the EchoPAC BT13 workstation. RESULTS Patients with APA, compared with those with primary hypertension and IHA, had a significantly (P < 0.001) lower serum potassium concentration and plasma renin activity, and higher 24-h urinary aldosterone, plasma aldosterone concentration, and aldosterone-to-renin ratio. Left ventricular ejection fraction was normal in all patients (58-60%). Layer-specific strain showed decreasing gradient from the endocardium to epicardium in all 3 groups (P < 0.01). However, LSendo and CSendo were lowest in APA (-20.2 ± 2.3% and -33.3 ± 3.2%), intermediate in IHA (-22.1 ± 1.9% and -35.7 ± 2.8%) and highest in primary hypertension (-24.1 ± 2.1% and -38.9 ± 3.1%, P < 0.001). Similar trends were observed for LSmid, LSepi, CSmid, and CSepi, but statistical significance was only reached for the comparison between APA and primary hypertension (P < 0.001), but not others (P > 0.05). Layer-specific strain was significantly correlated with plasma aldosterone concentration for all echocardiographic parameters (r = -0.69 to -0.53, P < 0.001) in all 3 groups. CONCLUSIONS Patients with PA, especially APA, had impaired regional systolic function with myocardial deformation changes at similar levels of blood pressure, probably because of elevated plasma aldosterone concentration.
Collapse
Affiliation(s)
- Dian Wang
- The Shanghai Institute of Hypertension, Department of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Jian-Zhong Xu
- The Shanghai Institute of Hypertension, Department of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Xin Chen
- Department of Hypertension, Ruijin Hospital North, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yi Chen
- The Shanghai Institute of Hypertension, Department of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Shuai Shao
- The Shanghai Institute of Hypertension, Department of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Wei Zhang
- The Shanghai Institute of Hypertension, Department of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Li-Min Zhu
- The Shanghai Institute of Hypertension, Department of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Ting-Yan Xu
- The Shanghai Institute of Hypertension, Department of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yan Li
- The Shanghai Institute of Hypertension, Department of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Ji-Guang Wang
- The Shanghai Institute of Hypertension, Department of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- Department of Hypertension, Ruijin Hospital North, Shanghai Jiaotong University School of Medicine, Shanghai, China
| |
Collapse
|
44
|
Ueland GÅ, Methlie P, Jøssang DE, Sagen JV, Viste K, Thordarson HB, Heie A, Grytaas M, Løvås K, Biermann M, Husebye ES. Adrenal Venous Sampling for Assessment of Autonomous Cortisol Secretion. J Clin Endocrinol Metab 2018; 103:4553-4560. [PMID: 30137397 DOI: 10.1210/jc.2018-01198] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 08/15/2018] [Indexed: 02/09/2023]
Abstract
CONTEXT Autonomous cortisol secretion (ACS) can be unilateral or bilateral irrespective of the presence of an adrenal tumor. A reliable method to distinguish between unilateral and bilateral ACS is lacking. OBJECTIVE Evaluate the use of adrenal venous sampling (AVS) to distinguish between unilateral and bilateral ACS. DESIGN AND METHODS This was a prospective study of AVS in patients with adrenal tumors who received a diagnosis of ACS or adrenal Cushing syndrome (CS). Unilateral secretion was defined as >2.3-fold difference in cortisol levels between the two adrenal veins. Metanephrine levels were used to ascertain correct catheter position. Results were correlated with findings on CT and iodine-131-cholesterol scintigraphy. RESULTS Thirty-nine patients underwent AVS; there were no complications. The procedure was inconclusive in six patients and repeated with success in one, giving a success rate of 85%, and leaving 34 procedures for evaluation (adrenal CS, n = 2; ACS, n = 32). Of 14 patients with bilateral tumors, 10 had bilateral and 4 had unilateral overproduction. Of 20 patients with unilateral tumors, 11 had lateralization to the side of the tumor and the remaining had bilateral secretion. Cholesterol scintigraphy findings were concordant with those of AVS in 13 of 18 cases (72%) and discordant in 5 (28%). CONCLUSION Laterality of ACS does not always correspond to findings on CT images. AVS is a safe and valuable tool for differentiation between unilateral and bilateral cortisol secretion and should be considered when operative treatment of ACS is a possibility.
Collapse
Affiliation(s)
- Grethe Å Ueland
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Medicine, Haukeland University Hospital, Bergen, Norway
| | - Paal Methlie
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Medicine, Haukeland University Hospital, Bergen, Norway
- K.G. Jebsen Center for Autoimmune Disorders, University of Bergen, Bergen, Norway
| | - Dag Eirik Jøssang
- Department of Radiology, Haukeland University Hospital, Bergen, Norway
| | - Jørn V Sagen
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of The Hormone Laboratory, Haukeland University Hospital, Bergen, Norway
| | - Kristin Viste
- Department of The Hormone Laboratory, Haukeland University Hospital, Bergen, Norway
| | | | - Anette Heie
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Surgery, Haukeland University Hospital, Bergen, Norway
| | - Marianne Grytaas
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Medicine, Haukeland University Hospital, Bergen, Norway
| | - Kristian Løvås
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Medicine, Haukeland University Hospital, Bergen, Norway
- K.G. Jebsen Center for Autoimmune Disorders, University of Bergen, Bergen, Norway
| | - Martin Biermann
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Radiology, Haukeland University Hospital, Bergen, Norway
| | - Eystein S Husebye
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Medicine, Haukeland University Hospital, Bergen, Norway
- K.G. Jebsen Center for Autoimmune Disorders, University of Bergen, Bergen, Norway
| |
Collapse
|
45
|
Jakobsson H, Farmaki K, Sakinis A, Ehn O, Johannsson G, Ragnarsson O. Adrenal venous sampling: the learning curve of a single interventionalist with 282 consecutive procedures. ACTA ACUST UNITED AC 2018; 24:89-93. [PMID: 29467114 DOI: 10.5152/dir.2018.17397] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
PURPOSE Primary aldosteronism (PA) is a common cause of secondary hypertension. Adrenal venous sampling (AVS) is the gold standard for assessing laterality of PA, which is of paramount importance to decide adequate treatment. AVS is a technically complicated procedure with success rates ranging between 30% and 96%. The aim of this study was to investigate the success rate of AVS over time, performed by a single interventionalist. METHODS This was a retrospective study based on consecutive AVS procedures performed by a single operator between September 2005 and June 2016. Data on serum concentrations of aldosterone and cortisol from right and left adrenal vein, inferior vena cava, and peripheral vein were collected and selectivity index (SI) calculated. Successful AVS was defined as SI > 5. RESULTS In total, 282 AVS procedures were performed on 269 patients, 168 men (62%) and 101 women (38%), with a mean age of 55±11 years (range, 26-78 years). Out of 282 AVS procedures, 259 were successful, giving an overall success rate of 92%. The most common reason for failure was inability to localize the right adrenal vein (n=16; 76%). The success rates were 63%, 82%, and 94% during the first, second, and third years, respectively. During the last 8 years the success rate was 95%, and on average 27 procedures were performed annually. CONCLUSION Satisfactory AVS success rate was achieved after approximately 36 procedures and satisfactory success rate was maintained by performing approximately 27 procedures annually. AVS should be limited to few operators that perform sufficiently large number of procedures to achieve, and maintain, satisfactory AVS success rate.
Collapse
Affiliation(s)
- Hugo Jakobsson
- Institution of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden; Department of Endocrinology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Katerina Farmaki
- Institution of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden; Department of Endocrinology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Augustinas Sakinis
- Department of Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Olof Ehn
- Institution of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden; Department of Endocrinology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Gudmundur Johannsson
- Institution of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden; Department of Endocrinology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Oskar Ragnarsson
- Institution of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden; Department of Endocrinology, Sahlgrenska University Hospital, Gothenburg, Sweden
| |
Collapse
|
46
|
Umakoshi H, Tsuiki M, Takeda Y, Kurihara I, Itoh H, Katabami T, Ichijo T, Wada N, Yoshimoto T, Ogawa Y, Kawashima J, Sone M, Inagaki N, Takahashi K, Watanabe M, Matsuda Y, Kobayashi H, Shibata H, Kamemura K, Otsuki M, Fujii Y, Yamamto K, Ogo A, Yanase T, Suzuki T, Naruse M. Significance of Computed Tomography and Serum Potassium in Predicting Subtype Diagnosis of Primary Aldosteronism. J Clin Endocrinol Metab 2018; 103:900-908. [PMID: 29092077 DOI: 10.1210/jc.2017-01774] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 10/03/2017] [Indexed: 02/04/2023]
Abstract
CONTEXT The number of centers with established adrenal venous sampling (AVS) programs for the subtype diagnosis of primary aldosteronism (PA) is limited. OBJECTIVE Aim was to develop an algorithm for AVS based on subtype prediction by computed tomography (CT) and serum potassium. DESIGN A multi-institutional retrospective cohort study in Japan. PATIENTS A total of 1591 patients with PA were classified into four groups according to CT findings and potassium status. Subtype diagnosis of PA was determined by AVS. MAIN OUTCOME MEASURE Prediction value of the combination of CT findings and potassium status for subtype diagnosis. RESULTS The percentages of unilateral hyperaldosteronism on AVS were higher in patients with unilateral disease on CT than those with bilateral normal results on CT (50.8% vs 14.6%, P < 0.01), and these percentages were higher in those with hypokalemia than those with normokalemia (58.4% vs 11.5%, P < 0.01). The prevalence and odds ratio for unilateral hyperaldosteronism on AVS were as follows: bilateral normal on CT with normokalemia, 6.2% (reference); unilateral disease on CT with normokalemia, 23.8% and 4.8 [95% confidence interval (CI), 3.1 to 7.2]; bilateral normal on CT with hypokalemia, 38.1% and 9.4 (95% CI, 6.2 to 14.1), and unilateral disease on CT with hypokalemia, 70.6% and 36.4 (95% CI, 24.7 to 53.5). CONCLUSIONS Patients with PA with bilateral normal results on CT and normokalemia likely have a low prior probability of a lateralized form of AVS and could be treated medically, whereas those with unilateral disease on CT and hypokalemia have a high probability of a lateralized form of AVS.
Collapse
Affiliation(s)
- Hironobu Umakoshi
- Department of Endocrinology and Metabolism, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Mika Tsuiki
- Department of Endocrinology and Metabolism, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Yoshiyu Takeda
- Department of Internal Medicine, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan
| | - Isao Kurihara
- Department of Endocrinology, Metabolism and Nephrology, School of Medicine, Keio University, Tokyo, Japan
| | - Hiroshi Itoh
- Department of Endocrinology, Metabolism and Nephrology, School of Medicine, Keio University, Tokyo, Japan
| | - Takuyuki Katabami
- Division of Metabolism and Endocrinology, Department of Internal Medicine, St. Marianna University School of Medicine Yokohama City Seibu Hospital, Yokohama, Japan
| | - Takamasa Ichijo
- Department of Endocrinology and Metabolism, Saiseikai Yokohamashi Tobu Hospital, Yokohama, Japan
| | - Norio Wada
- Department of Diabetes and Endocrinology, Sapporo City General Hospital, Sapporo, Japan
| | - Takanobu Yoshimoto
- Department of Molecular Endocrinology and Metabolism, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yoshihiro Ogawa
- Department of Molecular Endocrinology and Metabolism, Tokyo Medical and Dental University, Tokyo, Japan
| | - Junji Kawashima
- Department of Metabolic Medicine, Faculty of Life Science, Kumamoto University, Kumamoto University, Kumamoto, Japan
| | - Masakatsu Sone
- Department of Diabetes, Endocrinology and Nutrition Kyoto University, Kyoto, Japan
| | - Nobuya Inagaki
- Department of Diabetes, Endocrinology and Nutrition Kyoto University, Kyoto, Japan
| | - Katsutoshi Takahashi
- Division of Nephrology and Endocrinology, University of Tokyo School of Medicine, Tokyo, Japan
- Division of Metabolism, Showa General Hospital, Tokyo, Japan
| | - Minemori Watanabe
- Department of Endocrinology and Diabetes, Okazaki City Hospital, Okazaki, Japan
| | - Yuichi Matsuda
- Department of Cardiology, Sanda City Hospital, Sanda, Japan
| | - Hiroki Kobayashi
- Division of Nephrology, Hypertension and Endocrinology, Nihon University School of Medicine, Tokyo, Japan
| | - Hirotaka Shibata
- Department of Endocrinology, Metabolism, Rheumatology and Nephrology, Faculty of Medicine, Oita University, Yufu, Japan
| | - Kohei Kamemura
- Department of Cardiology, Akashi Medical Center, Akashi, Japan
| | - Michio Otsuki
- Department of Metabolic Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yuichi Fujii
- Department of Cardiology, JR Hiroshima Hospital, Hiroshima, Japan
| | - Koichi Yamamto
- Department of Geriatric and General Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Atsushi Ogo
- Clinical Research Institute, National Hospital Organization Kyusyu Medical Center, Fukuoka, Japan
| | - Toshihiko Yanase
- Department of Endocrinology and Diabetes Mellitus, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Tomoko Suzuki
- Department of Public Health, School of Medicine, International University of Health and Welfare, Narita, Japan
| | - Mitsuhide Naruse
- Department of Endocrinology and Metabolism, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | | |
Collapse
|
47
|
Risk of new-onset diabetes mellitus in primary aldosteronism: a population study over 5 years. J Hypertens 2018; 35:1698-1708. [PMID: 28661412 DOI: 10.1097/hjh.0000000000001361] [Citation(s) in RCA: 83] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVE Abnormal glucose metabolism due to insulin resistance has been linked to aldosterone overproduction. However, the long-term incidence of new-onset diabetes mellitus (NODM) among patients with primary aldosteronism after targeted treatment has not been well documented. METHODS The diagnosis of primary aldosteronism and essential hypertension were identified, and then the occurrence of NODM, all-cause mortality among these patients, was ascertained by a validated algorithm from a 23-million population insurance registry. RESULTS From 1999 to 2007, 2367 primary aldosteronism patients without previously diabetes mellitus were identified and propensity score-matched with 9468 patients with essential hypertension. Among those primary aldosteronism patients, 754 aldosterone-producing adenomas patients were identified and matched with 3016 essential hypertension controls. After a mean 5.2 years of follow-up, primary aldosteronism patients who underwent adrenalectomy had an attenuated NODM incidence (hazard ratio = 0.60, P < 0.01, versus essential hypertension); whereas those treated with mineralocorticoid receptor antagonist had augmented risk of NODM (hazard ratio = 1.16, P < 0.001, versus essential hypertension). Among the aldosterone-producing adenoma patients, adrenalectomy is also protective from developing NODM (hazard ratio = 0.61, P < 0.001, versus essential hypertension), however, mineralocorticoid receptor antagonist treatment did not alter the risk of NODM (P = 0.10, versus essential hypertension). Adjusted hazard ratios for long-term risk of mortality from this analysis revealed that adrenalectomy is protective, but NODM and major cardiovascular disease are deleterious. CONCLUSION The primary aldosteronism patients who underwent adrenalectomy had reduced risk for incident NODM and all-cause of mortality, compared with matched hypertensive controls. This observation adds more evidence on the association of primary aldosteronism with a higher risk of metabolic syndrome and long-term mortality.
Collapse
|
48
|
Heinze B, Fuss CT, Mulatero P, Beuschlein F, Reincke M, Mustafa M, Schirbel A, Deutschbein T, Williams TA, Rhayem Y, Quinkler M, Rayes N, Monticone S, Wild V, Gomez-Sanchez CE, Reis AC, Petersenn S, Wester HJ, Kropf S, Fassnacht M, Lang K, Herrmann K, Buck AK, Bluemel C, Hahner S. Targeting CXCR4 (CXC Chemokine Receptor Type 4) for Molecular Imaging of Aldosterone-Producing Adenoma. Hypertension 2017; 71:317-325. [PMID: 29279316 DOI: 10.1161/hypertensionaha.117.09975] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2017] [Revised: 07/25/2017] [Accepted: 11/28/2017] [Indexed: 12/20/2022]
Abstract
Primary aldosteronism is the most frequent cause of secondary hypertension and is associated with increased morbidity and mortality compared with hypertensive controls. The central diagnostic challenge is the differentiation between bilateral and unilateral disease, which determines treatment options. Bilateral adrenal venous sampling, currently recommended for differential diagnosis, is an invasive procedure with several drawbacks, making it desirable to develop novel noninvasive diagnostic tools. When investigating the expression pattern of chemokine receptors by quantitative real-time polymerase chain reaction and immunohistochemistry, we observed high expression of CXCR4 (CXC chemokine receptor type 4) in aldosterone-producing tissue in normal adrenals, adjacent adrenal cortex from adrenocortical adenomas, and in aldosterone-producing adenomas (APA), correlating strongly with the expression of CYP11B2 (aldosterone synthase). In contrast, CXCR4 was not detected in the majority of nonfunctioning adenomas that are frequently found coincidently. The specific CXCR4 ligand 68Ga-pentixafor has recently been established as radiotracer for molecular imaging of CXCR4 expression and showed strong and specific binding to cryosections of APAs in our study. We further investigated 9 patients with primary aldosteronism because of APA by 68Ga-pentixafor-positron emission tomography. The tracer uptake was significantly higher on the side of increased adrenocortical aldosterone secretion in patients with APAs compared with patients investigated by 68Ga-pentixafor-positron emission tomography for other causes. Molecular imaging of aldosterone-producing tissue by a CXCR4-specific ligand may, therefore, be a highly promising tool for noninvasive characterization of patients with APAs.
Collapse
Affiliation(s)
- Britta Heinze
- From the Department of Internal Medicine I, Endocrinology and Diabetes Unit (B.H., C.T.F., M.F., K.L., S.H.), Department of Nuclear Medicine (A.S., K.H., A.K.B., C.B.), and Comprehensive Cancer Center Wuerzburg (T.D., M.F.), University Hospital of Wuerzburg, University of Wuerzburg, Germany; Division of Internal Medicine and Hypertension, Department of Medical Sciences, University of Torino, Italy (P.M., T.A.W., S.M.); Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Germany (F.B., M.R., T.A.W., Y.R.); Department of Nuclear Medicine, Klinikum rechts der Isar der Technischen Universität München, Germany (M.M.); Endocrinology in Charlottenburg, Berlin, Germany (M.Q.); Department of General, Visceral, and Transplant Surgery, Campus Virchow Klinikum, Charité-Universitätsmedizin Berlin, Germany (N.R.); Department of Pathology, University of Würzburg, Germany (V.W.); Division of Endocrinology, G.V. (Sonny) Montgomery VA Medical Center, MS (C.E.G.-S.); Institute of Pathology, University Hospital Essen, University of Duisburg-Essen, Germany (A.-C.R.); ENDOC, Center for Endocrine Tumors, Hamburg, Germany (S.P.); Pharmaceutical Radiochemistry, Technische Universität München, Garching bei München, Germany (H.-J.W.); and Scintomics GmbH, Fürstenfeldbruck, Germany (S.K.)
| | - Carmina T Fuss
- From the Department of Internal Medicine I, Endocrinology and Diabetes Unit (B.H., C.T.F., M.F., K.L., S.H.), Department of Nuclear Medicine (A.S., K.H., A.K.B., C.B.), and Comprehensive Cancer Center Wuerzburg (T.D., M.F.), University Hospital of Wuerzburg, University of Wuerzburg, Germany; Division of Internal Medicine and Hypertension, Department of Medical Sciences, University of Torino, Italy (P.M., T.A.W., S.M.); Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Germany (F.B., M.R., T.A.W., Y.R.); Department of Nuclear Medicine, Klinikum rechts der Isar der Technischen Universität München, Germany (M.M.); Endocrinology in Charlottenburg, Berlin, Germany (M.Q.); Department of General, Visceral, and Transplant Surgery, Campus Virchow Klinikum, Charité-Universitätsmedizin Berlin, Germany (N.R.); Department of Pathology, University of Würzburg, Germany (V.W.); Division of Endocrinology, G.V. (Sonny) Montgomery VA Medical Center, MS (C.E.G.-S.); Institute of Pathology, University Hospital Essen, University of Duisburg-Essen, Germany (A.-C.R.); ENDOC, Center for Endocrine Tumors, Hamburg, Germany (S.P.); Pharmaceutical Radiochemistry, Technische Universität München, Garching bei München, Germany (H.-J.W.); and Scintomics GmbH, Fürstenfeldbruck, Germany (S.K.)
| | - Paolo Mulatero
- From the Department of Internal Medicine I, Endocrinology and Diabetes Unit (B.H., C.T.F., M.F., K.L., S.H.), Department of Nuclear Medicine (A.S., K.H., A.K.B., C.B.), and Comprehensive Cancer Center Wuerzburg (T.D., M.F.), University Hospital of Wuerzburg, University of Wuerzburg, Germany; Division of Internal Medicine and Hypertension, Department of Medical Sciences, University of Torino, Italy (P.M., T.A.W., S.M.); Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Germany (F.B., M.R., T.A.W., Y.R.); Department of Nuclear Medicine, Klinikum rechts der Isar der Technischen Universität München, Germany (M.M.); Endocrinology in Charlottenburg, Berlin, Germany (M.Q.); Department of General, Visceral, and Transplant Surgery, Campus Virchow Klinikum, Charité-Universitätsmedizin Berlin, Germany (N.R.); Department of Pathology, University of Würzburg, Germany (V.W.); Division of Endocrinology, G.V. (Sonny) Montgomery VA Medical Center, MS (C.E.G.-S.); Institute of Pathology, University Hospital Essen, University of Duisburg-Essen, Germany (A.-C.R.); ENDOC, Center for Endocrine Tumors, Hamburg, Germany (S.P.); Pharmaceutical Radiochemistry, Technische Universität München, Garching bei München, Germany (H.-J.W.); and Scintomics GmbH, Fürstenfeldbruck, Germany (S.K.)
| | - Felix Beuschlein
- From the Department of Internal Medicine I, Endocrinology and Diabetes Unit (B.H., C.T.F., M.F., K.L., S.H.), Department of Nuclear Medicine (A.S., K.H., A.K.B., C.B.), and Comprehensive Cancer Center Wuerzburg (T.D., M.F.), University Hospital of Wuerzburg, University of Wuerzburg, Germany; Division of Internal Medicine and Hypertension, Department of Medical Sciences, University of Torino, Italy (P.M., T.A.W., S.M.); Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Germany (F.B., M.R., T.A.W., Y.R.); Department of Nuclear Medicine, Klinikum rechts der Isar der Technischen Universität München, Germany (M.M.); Endocrinology in Charlottenburg, Berlin, Germany (M.Q.); Department of General, Visceral, and Transplant Surgery, Campus Virchow Klinikum, Charité-Universitätsmedizin Berlin, Germany (N.R.); Department of Pathology, University of Würzburg, Germany (V.W.); Division of Endocrinology, G.V. (Sonny) Montgomery VA Medical Center, MS (C.E.G.-S.); Institute of Pathology, University Hospital Essen, University of Duisburg-Essen, Germany (A.-C.R.); ENDOC, Center for Endocrine Tumors, Hamburg, Germany (S.P.); Pharmaceutical Radiochemistry, Technische Universität München, Garching bei München, Germany (H.-J.W.); and Scintomics GmbH, Fürstenfeldbruck, Germany (S.K.)
| | - Martin Reincke
- From the Department of Internal Medicine I, Endocrinology and Diabetes Unit (B.H., C.T.F., M.F., K.L., S.H.), Department of Nuclear Medicine (A.S., K.H., A.K.B., C.B.), and Comprehensive Cancer Center Wuerzburg (T.D., M.F.), University Hospital of Wuerzburg, University of Wuerzburg, Germany; Division of Internal Medicine and Hypertension, Department of Medical Sciences, University of Torino, Italy (P.M., T.A.W., S.M.); Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Germany (F.B., M.R., T.A.W., Y.R.); Department of Nuclear Medicine, Klinikum rechts der Isar der Technischen Universität München, Germany (M.M.); Endocrinology in Charlottenburg, Berlin, Germany (M.Q.); Department of General, Visceral, and Transplant Surgery, Campus Virchow Klinikum, Charité-Universitätsmedizin Berlin, Germany (N.R.); Department of Pathology, University of Würzburg, Germany (V.W.); Division of Endocrinology, G.V. (Sonny) Montgomery VA Medical Center, MS (C.E.G.-S.); Institute of Pathology, University Hospital Essen, University of Duisburg-Essen, Germany (A.-C.R.); ENDOC, Center for Endocrine Tumors, Hamburg, Germany (S.P.); Pharmaceutical Radiochemistry, Technische Universität München, Garching bei München, Germany (H.-J.W.); and Scintomics GmbH, Fürstenfeldbruck, Germany (S.K.)
| | - Mona Mustafa
- From the Department of Internal Medicine I, Endocrinology and Diabetes Unit (B.H., C.T.F., M.F., K.L., S.H.), Department of Nuclear Medicine (A.S., K.H., A.K.B., C.B.), and Comprehensive Cancer Center Wuerzburg (T.D., M.F.), University Hospital of Wuerzburg, University of Wuerzburg, Germany; Division of Internal Medicine and Hypertension, Department of Medical Sciences, University of Torino, Italy (P.M., T.A.W., S.M.); Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Germany (F.B., M.R., T.A.W., Y.R.); Department of Nuclear Medicine, Klinikum rechts der Isar der Technischen Universität München, Germany (M.M.); Endocrinology in Charlottenburg, Berlin, Germany (M.Q.); Department of General, Visceral, and Transplant Surgery, Campus Virchow Klinikum, Charité-Universitätsmedizin Berlin, Germany (N.R.); Department of Pathology, University of Würzburg, Germany (V.W.); Division of Endocrinology, G.V. (Sonny) Montgomery VA Medical Center, MS (C.E.G.-S.); Institute of Pathology, University Hospital Essen, University of Duisburg-Essen, Germany (A.-C.R.); ENDOC, Center for Endocrine Tumors, Hamburg, Germany (S.P.); Pharmaceutical Radiochemistry, Technische Universität München, Garching bei München, Germany (H.-J.W.); and Scintomics GmbH, Fürstenfeldbruck, Germany (S.K.)
| | - Andreas Schirbel
- From the Department of Internal Medicine I, Endocrinology and Diabetes Unit (B.H., C.T.F., M.F., K.L., S.H.), Department of Nuclear Medicine (A.S., K.H., A.K.B., C.B.), and Comprehensive Cancer Center Wuerzburg (T.D., M.F.), University Hospital of Wuerzburg, University of Wuerzburg, Germany; Division of Internal Medicine and Hypertension, Department of Medical Sciences, University of Torino, Italy (P.M., T.A.W., S.M.); Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Germany (F.B., M.R., T.A.W., Y.R.); Department of Nuclear Medicine, Klinikum rechts der Isar der Technischen Universität München, Germany (M.M.); Endocrinology in Charlottenburg, Berlin, Germany (M.Q.); Department of General, Visceral, and Transplant Surgery, Campus Virchow Klinikum, Charité-Universitätsmedizin Berlin, Germany (N.R.); Department of Pathology, University of Würzburg, Germany (V.W.); Division of Endocrinology, G.V. (Sonny) Montgomery VA Medical Center, MS (C.E.G.-S.); Institute of Pathology, University Hospital Essen, University of Duisburg-Essen, Germany (A.-C.R.); ENDOC, Center for Endocrine Tumors, Hamburg, Germany (S.P.); Pharmaceutical Radiochemistry, Technische Universität München, Garching bei München, Germany (H.-J.W.); and Scintomics GmbH, Fürstenfeldbruck, Germany (S.K.)
| | - Timo Deutschbein
- From the Department of Internal Medicine I, Endocrinology and Diabetes Unit (B.H., C.T.F., M.F., K.L., S.H.), Department of Nuclear Medicine (A.S., K.H., A.K.B., C.B.), and Comprehensive Cancer Center Wuerzburg (T.D., M.F.), University Hospital of Wuerzburg, University of Wuerzburg, Germany; Division of Internal Medicine and Hypertension, Department of Medical Sciences, University of Torino, Italy (P.M., T.A.W., S.M.); Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Germany (F.B., M.R., T.A.W., Y.R.); Department of Nuclear Medicine, Klinikum rechts der Isar der Technischen Universität München, Germany (M.M.); Endocrinology in Charlottenburg, Berlin, Germany (M.Q.); Department of General, Visceral, and Transplant Surgery, Campus Virchow Klinikum, Charité-Universitätsmedizin Berlin, Germany (N.R.); Department of Pathology, University of Würzburg, Germany (V.W.); Division of Endocrinology, G.V. (Sonny) Montgomery VA Medical Center, MS (C.E.G.-S.); Institute of Pathology, University Hospital Essen, University of Duisburg-Essen, Germany (A.-C.R.); ENDOC, Center for Endocrine Tumors, Hamburg, Germany (S.P.); Pharmaceutical Radiochemistry, Technische Universität München, Garching bei München, Germany (H.-J.W.); and Scintomics GmbH, Fürstenfeldbruck, Germany (S.K.)
| | - Tracy Ann Williams
- From the Department of Internal Medicine I, Endocrinology and Diabetes Unit (B.H., C.T.F., M.F., K.L., S.H.), Department of Nuclear Medicine (A.S., K.H., A.K.B., C.B.), and Comprehensive Cancer Center Wuerzburg (T.D., M.F.), University Hospital of Wuerzburg, University of Wuerzburg, Germany; Division of Internal Medicine and Hypertension, Department of Medical Sciences, University of Torino, Italy (P.M., T.A.W., S.M.); Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Germany (F.B., M.R., T.A.W., Y.R.); Department of Nuclear Medicine, Klinikum rechts der Isar der Technischen Universität München, Germany (M.M.); Endocrinology in Charlottenburg, Berlin, Germany (M.Q.); Department of General, Visceral, and Transplant Surgery, Campus Virchow Klinikum, Charité-Universitätsmedizin Berlin, Germany (N.R.); Department of Pathology, University of Würzburg, Germany (V.W.); Division of Endocrinology, G.V. (Sonny) Montgomery VA Medical Center, MS (C.E.G.-S.); Institute of Pathology, University Hospital Essen, University of Duisburg-Essen, Germany (A.-C.R.); ENDOC, Center for Endocrine Tumors, Hamburg, Germany (S.P.); Pharmaceutical Radiochemistry, Technische Universität München, Garching bei München, Germany (H.-J.W.); and Scintomics GmbH, Fürstenfeldbruck, Germany (S.K.)
| | - Yara Rhayem
- From the Department of Internal Medicine I, Endocrinology and Diabetes Unit (B.H., C.T.F., M.F., K.L., S.H.), Department of Nuclear Medicine (A.S., K.H., A.K.B., C.B.), and Comprehensive Cancer Center Wuerzburg (T.D., M.F.), University Hospital of Wuerzburg, University of Wuerzburg, Germany; Division of Internal Medicine and Hypertension, Department of Medical Sciences, University of Torino, Italy (P.M., T.A.W., S.M.); Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Germany (F.B., M.R., T.A.W., Y.R.); Department of Nuclear Medicine, Klinikum rechts der Isar der Technischen Universität München, Germany (M.M.); Endocrinology in Charlottenburg, Berlin, Germany (M.Q.); Department of General, Visceral, and Transplant Surgery, Campus Virchow Klinikum, Charité-Universitätsmedizin Berlin, Germany (N.R.); Department of Pathology, University of Würzburg, Germany (V.W.); Division of Endocrinology, G.V. (Sonny) Montgomery VA Medical Center, MS (C.E.G.-S.); Institute of Pathology, University Hospital Essen, University of Duisburg-Essen, Germany (A.-C.R.); ENDOC, Center for Endocrine Tumors, Hamburg, Germany (S.P.); Pharmaceutical Radiochemistry, Technische Universität München, Garching bei München, Germany (H.-J.W.); and Scintomics GmbH, Fürstenfeldbruck, Germany (S.K.)
| | - Marcus Quinkler
- From the Department of Internal Medicine I, Endocrinology and Diabetes Unit (B.H., C.T.F., M.F., K.L., S.H.), Department of Nuclear Medicine (A.S., K.H., A.K.B., C.B.), and Comprehensive Cancer Center Wuerzburg (T.D., M.F.), University Hospital of Wuerzburg, University of Wuerzburg, Germany; Division of Internal Medicine and Hypertension, Department of Medical Sciences, University of Torino, Italy (P.M., T.A.W., S.M.); Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Germany (F.B., M.R., T.A.W., Y.R.); Department of Nuclear Medicine, Klinikum rechts der Isar der Technischen Universität München, Germany (M.M.); Endocrinology in Charlottenburg, Berlin, Germany (M.Q.); Department of General, Visceral, and Transplant Surgery, Campus Virchow Klinikum, Charité-Universitätsmedizin Berlin, Germany (N.R.); Department of Pathology, University of Würzburg, Germany (V.W.); Division of Endocrinology, G.V. (Sonny) Montgomery VA Medical Center, MS (C.E.G.-S.); Institute of Pathology, University Hospital Essen, University of Duisburg-Essen, Germany (A.-C.R.); ENDOC, Center for Endocrine Tumors, Hamburg, Germany (S.P.); Pharmaceutical Radiochemistry, Technische Universität München, Garching bei München, Germany (H.-J.W.); and Scintomics GmbH, Fürstenfeldbruck, Germany (S.K.)
| | - Nada Rayes
- From the Department of Internal Medicine I, Endocrinology and Diabetes Unit (B.H., C.T.F., M.F., K.L., S.H.), Department of Nuclear Medicine (A.S., K.H., A.K.B., C.B.), and Comprehensive Cancer Center Wuerzburg (T.D., M.F.), University Hospital of Wuerzburg, University of Wuerzburg, Germany; Division of Internal Medicine and Hypertension, Department of Medical Sciences, University of Torino, Italy (P.M., T.A.W., S.M.); Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Germany (F.B., M.R., T.A.W., Y.R.); Department of Nuclear Medicine, Klinikum rechts der Isar der Technischen Universität München, Germany (M.M.); Endocrinology in Charlottenburg, Berlin, Germany (M.Q.); Department of General, Visceral, and Transplant Surgery, Campus Virchow Klinikum, Charité-Universitätsmedizin Berlin, Germany (N.R.); Department of Pathology, University of Würzburg, Germany (V.W.); Division of Endocrinology, G.V. (Sonny) Montgomery VA Medical Center, MS (C.E.G.-S.); Institute of Pathology, University Hospital Essen, University of Duisburg-Essen, Germany (A.-C.R.); ENDOC, Center for Endocrine Tumors, Hamburg, Germany (S.P.); Pharmaceutical Radiochemistry, Technische Universität München, Garching bei München, Germany (H.-J.W.); and Scintomics GmbH, Fürstenfeldbruck, Germany (S.K.)
| | - Silvia Monticone
- From the Department of Internal Medicine I, Endocrinology and Diabetes Unit (B.H., C.T.F., M.F., K.L., S.H.), Department of Nuclear Medicine (A.S., K.H., A.K.B., C.B.), and Comprehensive Cancer Center Wuerzburg (T.D., M.F.), University Hospital of Wuerzburg, University of Wuerzburg, Germany; Division of Internal Medicine and Hypertension, Department of Medical Sciences, University of Torino, Italy (P.M., T.A.W., S.M.); Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Germany (F.B., M.R., T.A.W., Y.R.); Department of Nuclear Medicine, Klinikum rechts der Isar der Technischen Universität München, Germany (M.M.); Endocrinology in Charlottenburg, Berlin, Germany (M.Q.); Department of General, Visceral, and Transplant Surgery, Campus Virchow Klinikum, Charité-Universitätsmedizin Berlin, Germany (N.R.); Department of Pathology, University of Würzburg, Germany (V.W.); Division of Endocrinology, G.V. (Sonny) Montgomery VA Medical Center, MS (C.E.G.-S.); Institute of Pathology, University Hospital Essen, University of Duisburg-Essen, Germany (A.-C.R.); ENDOC, Center for Endocrine Tumors, Hamburg, Germany (S.P.); Pharmaceutical Radiochemistry, Technische Universität München, Garching bei München, Germany (H.-J.W.); and Scintomics GmbH, Fürstenfeldbruck, Germany (S.K.)
| | - Vanessa Wild
- From the Department of Internal Medicine I, Endocrinology and Diabetes Unit (B.H., C.T.F., M.F., K.L., S.H.), Department of Nuclear Medicine (A.S., K.H., A.K.B., C.B.), and Comprehensive Cancer Center Wuerzburg (T.D., M.F.), University Hospital of Wuerzburg, University of Wuerzburg, Germany; Division of Internal Medicine and Hypertension, Department of Medical Sciences, University of Torino, Italy (P.M., T.A.W., S.M.); Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Germany (F.B., M.R., T.A.W., Y.R.); Department of Nuclear Medicine, Klinikum rechts der Isar der Technischen Universität München, Germany (M.M.); Endocrinology in Charlottenburg, Berlin, Germany (M.Q.); Department of General, Visceral, and Transplant Surgery, Campus Virchow Klinikum, Charité-Universitätsmedizin Berlin, Germany (N.R.); Department of Pathology, University of Würzburg, Germany (V.W.); Division of Endocrinology, G.V. (Sonny) Montgomery VA Medical Center, MS (C.E.G.-S.); Institute of Pathology, University Hospital Essen, University of Duisburg-Essen, Germany (A.-C.R.); ENDOC, Center for Endocrine Tumors, Hamburg, Germany (S.P.); Pharmaceutical Radiochemistry, Technische Universität München, Garching bei München, Germany (H.-J.W.); and Scintomics GmbH, Fürstenfeldbruck, Germany (S.K.)
| | - Celso E Gomez-Sanchez
- From the Department of Internal Medicine I, Endocrinology and Diabetes Unit (B.H., C.T.F., M.F., K.L., S.H.), Department of Nuclear Medicine (A.S., K.H., A.K.B., C.B.), and Comprehensive Cancer Center Wuerzburg (T.D., M.F.), University Hospital of Wuerzburg, University of Wuerzburg, Germany; Division of Internal Medicine and Hypertension, Department of Medical Sciences, University of Torino, Italy (P.M., T.A.W., S.M.); Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Germany (F.B., M.R., T.A.W., Y.R.); Department of Nuclear Medicine, Klinikum rechts der Isar der Technischen Universität München, Germany (M.M.); Endocrinology in Charlottenburg, Berlin, Germany (M.Q.); Department of General, Visceral, and Transplant Surgery, Campus Virchow Klinikum, Charité-Universitätsmedizin Berlin, Germany (N.R.); Department of Pathology, University of Würzburg, Germany (V.W.); Division of Endocrinology, G.V. (Sonny) Montgomery VA Medical Center, MS (C.E.G.-S.); Institute of Pathology, University Hospital Essen, University of Duisburg-Essen, Germany (A.-C.R.); ENDOC, Center for Endocrine Tumors, Hamburg, Germany (S.P.); Pharmaceutical Radiochemistry, Technische Universität München, Garching bei München, Germany (H.-J.W.); and Scintomics GmbH, Fürstenfeldbruck, Germany (S.K.)
| | - Anna-Carinna Reis
- From the Department of Internal Medicine I, Endocrinology and Diabetes Unit (B.H., C.T.F., M.F., K.L., S.H.), Department of Nuclear Medicine (A.S., K.H., A.K.B., C.B.), and Comprehensive Cancer Center Wuerzburg (T.D., M.F.), University Hospital of Wuerzburg, University of Wuerzburg, Germany; Division of Internal Medicine and Hypertension, Department of Medical Sciences, University of Torino, Italy (P.M., T.A.W., S.M.); Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Germany (F.B., M.R., T.A.W., Y.R.); Department of Nuclear Medicine, Klinikum rechts der Isar der Technischen Universität München, Germany (M.M.); Endocrinology in Charlottenburg, Berlin, Germany (M.Q.); Department of General, Visceral, and Transplant Surgery, Campus Virchow Klinikum, Charité-Universitätsmedizin Berlin, Germany (N.R.); Department of Pathology, University of Würzburg, Germany (V.W.); Division of Endocrinology, G.V. (Sonny) Montgomery VA Medical Center, MS (C.E.G.-S.); Institute of Pathology, University Hospital Essen, University of Duisburg-Essen, Germany (A.-C.R.); ENDOC, Center for Endocrine Tumors, Hamburg, Germany (S.P.); Pharmaceutical Radiochemistry, Technische Universität München, Garching bei München, Germany (H.-J.W.); and Scintomics GmbH, Fürstenfeldbruck, Germany (S.K.)
| | - Stephan Petersenn
- From the Department of Internal Medicine I, Endocrinology and Diabetes Unit (B.H., C.T.F., M.F., K.L., S.H.), Department of Nuclear Medicine (A.S., K.H., A.K.B., C.B.), and Comprehensive Cancer Center Wuerzburg (T.D., M.F.), University Hospital of Wuerzburg, University of Wuerzburg, Germany; Division of Internal Medicine and Hypertension, Department of Medical Sciences, University of Torino, Italy (P.M., T.A.W., S.M.); Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Germany (F.B., M.R., T.A.W., Y.R.); Department of Nuclear Medicine, Klinikum rechts der Isar der Technischen Universität München, Germany (M.M.); Endocrinology in Charlottenburg, Berlin, Germany (M.Q.); Department of General, Visceral, and Transplant Surgery, Campus Virchow Klinikum, Charité-Universitätsmedizin Berlin, Germany (N.R.); Department of Pathology, University of Würzburg, Germany (V.W.); Division of Endocrinology, G.V. (Sonny) Montgomery VA Medical Center, MS (C.E.G.-S.); Institute of Pathology, University Hospital Essen, University of Duisburg-Essen, Germany (A.-C.R.); ENDOC, Center for Endocrine Tumors, Hamburg, Germany (S.P.); Pharmaceutical Radiochemistry, Technische Universität München, Garching bei München, Germany (H.-J.W.); and Scintomics GmbH, Fürstenfeldbruck, Germany (S.K.)
| | - Hans-Juergen Wester
- From the Department of Internal Medicine I, Endocrinology and Diabetes Unit (B.H., C.T.F., M.F., K.L., S.H.), Department of Nuclear Medicine (A.S., K.H., A.K.B., C.B.), and Comprehensive Cancer Center Wuerzburg (T.D., M.F.), University Hospital of Wuerzburg, University of Wuerzburg, Germany; Division of Internal Medicine and Hypertension, Department of Medical Sciences, University of Torino, Italy (P.M., T.A.W., S.M.); Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Germany (F.B., M.R., T.A.W., Y.R.); Department of Nuclear Medicine, Klinikum rechts der Isar der Technischen Universität München, Germany (M.M.); Endocrinology in Charlottenburg, Berlin, Germany (M.Q.); Department of General, Visceral, and Transplant Surgery, Campus Virchow Klinikum, Charité-Universitätsmedizin Berlin, Germany (N.R.); Department of Pathology, University of Würzburg, Germany (V.W.); Division of Endocrinology, G.V. (Sonny) Montgomery VA Medical Center, MS (C.E.G.-S.); Institute of Pathology, University Hospital Essen, University of Duisburg-Essen, Germany (A.-C.R.); ENDOC, Center for Endocrine Tumors, Hamburg, Germany (S.P.); Pharmaceutical Radiochemistry, Technische Universität München, Garching bei München, Germany (H.-J.W.); and Scintomics GmbH, Fürstenfeldbruck, Germany (S.K.)
| | - Saskia Kropf
- From the Department of Internal Medicine I, Endocrinology and Diabetes Unit (B.H., C.T.F., M.F., K.L., S.H.), Department of Nuclear Medicine (A.S., K.H., A.K.B., C.B.), and Comprehensive Cancer Center Wuerzburg (T.D., M.F.), University Hospital of Wuerzburg, University of Wuerzburg, Germany; Division of Internal Medicine and Hypertension, Department of Medical Sciences, University of Torino, Italy (P.M., T.A.W., S.M.); Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Germany (F.B., M.R., T.A.W., Y.R.); Department of Nuclear Medicine, Klinikum rechts der Isar der Technischen Universität München, Germany (M.M.); Endocrinology in Charlottenburg, Berlin, Germany (M.Q.); Department of General, Visceral, and Transplant Surgery, Campus Virchow Klinikum, Charité-Universitätsmedizin Berlin, Germany (N.R.); Department of Pathology, University of Würzburg, Germany (V.W.); Division of Endocrinology, G.V. (Sonny) Montgomery VA Medical Center, MS (C.E.G.-S.); Institute of Pathology, University Hospital Essen, University of Duisburg-Essen, Germany (A.-C.R.); ENDOC, Center for Endocrine Tumors, Hamburg, Germany (S.P.); Pharmaceutical Radiochemistry, Technische Universität München, Garching bei München, Germany (H.-J.W.); and Scintomics GmbH, Fürstenfeldbruck, Germany (S.K.)
| | - Martin Fassnacht
- From the Department of Internal Medicine I, Endocrinology and Diabetes Unit (B.H., C.T.F., M.F., K.L., S.H.), Department of Nuclear Medicine (A.S., K.H., A.K.B., C.B.), and Comprehensive Cancer Center Wuerzburg (T.D., M.F.), University Hospital of Wuerzburg, University of Wuerzburg, Germany; Division of Internal Medicine and Hypertension, Department of Medical Sciences, University of Torino, Italy (P.M., T.A.W., S.M.); Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Germany (F.B., M.R., T.A.W., Y.R.); Department of Nuclear Medicine, Klinikum rechts der Isar der Technischen Universität München, Germany (M.M.); Endocrinology in Charlottenburg, Berlin, Germany (M.Q.); Department of General, Visceral, and Transplant Surgery, Campus Virchow Klinikum, Charité-Universitätsmedizin Berlin, Germany (N.R.); Department of Pathology, University of Würzburg, Germany (V.W.); Division of Endocrinology, G.V. (Sonny) Montgomery VA Medical Center, MS (C.E.G.-S.); Institute of Pathology, University Hospital Essen, University of Duisburg-Essen, Germany (A.-C.R.); ENDOC, Center for Endocrine Tumors, Hamburg, Germany (S.P.); Pharmaceutical Radiochemistry, Technische Universität München, Garching bei München, Germany (H.-J.W.); and Scintomics GmbH, Fürstenfeldbruck, Germany (S.K.)
| | - Katharina Lang
- From the Department of Internal Medicine I, Endocrinology and Diabetes Unit (B.H., C.T.F., M.F., K.L., S.H.), Department of Nuclear Medicine (A.S., K.H., A.K.B., C.B.), and Comprehensive Cancer Center Wuerzburg (T.D., M.F.), University Hospital of Wuerzburg, University of Wuerzburg, Germany; Division of Internal Medicine and Hypertension, Department of Medical Sciences, University of Torino, Italy (P.M., T.A.W., S.M.); Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Germany (F.B., M.R., T.A.W., Y.R.); Department of Nuclear Medicine, Klinikum rechts der Isar der Technischen Universität München, Germany (M.M.); Endocrinology in Charlottenburg, Berlin, Germany (M.Q.); Department of General, Visceral, and Transplant Surgery, Campus Virchow Klinikum, Charité-Universitätsmedizin Berlin, Germany (N.R.); Department of Pathology, University of Würzburg, Germany (V.W.); Division of Endocrinology, G.V. (Sonny) Montgomery VA Medical Center, MS (C.E.G.-S.); Institute of Pathology, University Hospital Essen, University of Duisburg-Essen, Germany (A.-C.R.); ENDOC, Center for Endocrine Tumors, Hamburg, Germany (S.P.); Pharmaceutical Radiochemistry, Technische Universität München, Garching bei München, Germany (H.-J.W.); and Scintomics GmbH, Fürstenfeldbruck, Germany (S.K.)
| | - Ken Herrmann
- From the Department of Internal Medicine I, Endocrinology and Diabetes Unit (B.H., C.T.F., M.F., K.L., S.H.), Department of Nuclear Medicine (A.S., K.H., A.K.B., C.B.), and Comprehensive Cancer Center Wuerzburg (T.D., M.F.), University Hospital of Wuerzburg, University of Wuerzburg, Germany; Division of Internal Medicine and Hypertension, Department of Medical Sciences, University of Torino, Italy (P.M., T.A.W., S.M.); Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Germany (F.B., M.R., T.A.W., Y.R.); Department of Nuclear Medicine, Klinikum rechts der Isar der Technischen Universität München, Germany (M.M.); Endocrinology in Charlottenburg, Berlin, Germany (M.Q.); Department of General, Visceral, and Transplant Surgery, Campus Virchow Klinikum, Charité-Universitätsmedizin Berlin, Germany (N.R.); Department of Pathology, University of Würzburg, Germany (V.W.); Division of Endocrinology, G.V. (Sonny) Montgomery VA Medical Center, MS (C.E.G.-S.); Institute of Pathology, University Hospital Essen, University of Duisburg-Essen, Germany (A.-C.R.); ENDOC, Center for Endocrine Tumors, Hamburg, Germany (S.P.); Pharmaceutical Radiochemistry, Technische Universität München, Garching bei München, Germany (H.-J.W.); and Scintomics GmbH, Fürstenfeldbruck, Germany (S.K.)
| | - Andreas K Buck
- From the Department of Internal Medicine I, Endocrinology and Diabetes Unit (B.H., C.T.F., M.F., K.L., S.H.), Department of Nuclear Medicine (A.S., K.H., A.K.B., C.B.), and Comprehensive Cancer Center Wuerzburg (T.D., M.F.), University Hospital of Wuerzburg, University of Wuerzburg, Germany; Division of Internal Medicine and Hypertension, Department of Medical Sciences, University of Torino, Italy (P.M., T.A.W., S.M.); Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Germany (F.B., M.R., T.A.W., Y.R.); Department of Nuclear Medicine, Klinikum rechts der Isar der Technischen Universität München, Germany (M.M.); Endocrinology in Charlottenburg, Berlin, Germany (M.Q.); Department of General, Visceral, and Transplant Surgery, Campus Virchow Klinikum, Charité-Universitätsmedizin Berlin, Germany (N.R.); Department of Pathology, University of Würzburg, Germany (V.W.); Division of Endocrinology, G.V. (Sonny) Montgomery VA Medical Center, MS (C.E.G.-S.); Institute of Pathology, University Hospital Essen, University of Duisburg-Essen, Germany (A.-C.R.); ENDOC, Center for Endocrine Tumors, Hamburg, Germany (S.P.); Pharmaceutical Radiochemistry, Technische Universität München, Garching bei München, Germany (H.-J.W.); and Scintomics GmbH, Fürstenfeldbruck, Germany (S.K.)
| | - Christina Bluemel
- From the Department of Internal Medicine I, Endocrinology and Diabetes Unit (B.H., C.T.F., M.F., K.L., S.H.), Department of Nuclear Medicine (A.S., K.H., A.K.B., C.B.), and Comprehensive Cancer Center Wuerzburg (T.D., M.F.), University Hospital of Wuerzburg, University of Wuerzburg, Germany; Division of Internal Medicine and Hypertension, Department of Medical Sciences, University of Torino, Italy (P.M., T.A.W., S.M.); Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Germany (F.B., M.R., T.A.W., Y.R.); Department of Nuclear Medicine, Klinikum rechts der Isar der Technischen Universität München, Germany (M.M.); Endocrinology in Charlottenburg, Berlin, Germany (M.Q.); Department of General, Visceral, and Transplant Surgery, Campus Virchow Klinikum, Charité-Universitätsmedizin Berlin, Germany (N.R.); Department of Pathology, University of Würzburg, Germany (V.W.); Division of Endocrinology, G.V. (Sonny) Montgomery VA Medical Center, MS (C.E.G.-S.); Institute of Pathology, University Hospital Essen, University of Duisburg-Essen, Germany (A.-C.R.); ENDOC, Center for Endocrine Tumors, Hamburg, Germany (S.P.); Pharmaceutical Radiochemistry, Technische Universität München, Garching bei München, Germany (H.-J.W.); and Scintomics GmbH, Fürstenfeldbruck, Germany (S.K.)
| | - Stefanie Hahner
- From the Department of Internal Medicine I, Endocrinology and Diabetes Unit (B.H., C.T.F., M.F., K.L., S.H.), Department of Nuclear Medicine (A.S., K.H., A.K.B., C.B.), and Comprehensive Cancer Center Wuerzburg (T.D., M.F.), University Hospital of Wuerzburg, University of Wuerzburg, Germany; Division of Internal Medicine and Hypertension, Department of Medical Sciences, University of Torino, Italy (P.M., T.A.W., S.M.); Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Germany (F.B., M.R., T.A.W., Y.R.); Department of Nuclear Medicine, Klinikum rechts der Isar der Technischen Universität München, Germany (M.M.); Endocrinology in Charlottenburg, Berlin, Germany (M.Q.); Department of General, Visceral, and Transplant Surgery, Campus Virchow Klinikum, Charité-Universitätsmedizin Berlin, Germany (N.R.); Department of Pathology, University of Würzburg, Germany (V.W.); Division of Endocrinology, G.V. (Sonny) Montgomery VA Medical Center, MS (C.E.G.-S.); Institute of Pathology, University Hospital Essen, University of Duisburg-Essen, Germany (A.-C.R.); ENDOC, Center for Endocrine Tumors, Hamburg, Germany (S.P.); Pharmaceutical Radiochemistry, Technische Universität München, Garching bei München, Germany (H.-J.W.); and Scintomics GmbH, Fürstenfeldbruck, Germany (S.K.).
| |
Collapse
|
49
|
Nanba AT, Nanba K, Byrd JB, Shields JJ, Giordano TJ, Miller BS, Rainey WE, Auchus RJ, Turcu AF. Discordance between imaging and immunohistochemistry in unilateral primary aldosteronism. Clin Endocrinol (Oxf) 2017; 87:665-672. [PMID: 28787766 PMCID: PMC5698145 DOI: 10.1111/cen.13442] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Revised: 07/26/2017] [Accepted: 08/02/2017] [Indexed: 01/23/2023]
Abstract
OBJECTIVE Correct subtyping of primary aldosteronism (PA) is essential for good surgical outcomes. Adrenal vein sampling (AVS) and/or computed tomography (CT) are used for PA subclassification. Clinical and/or biochemical improvement after surgery, however, is not always achieved in patients with presumed unilateral PA. We aimed to identify the pitfalls in PA subclassification leading to surgical treatment failures. PATIENTS AND DESIGN We retrospectively studied 208 patients who underwent adrenal vein sampling (AVS) for PA subclassification in a tertiary referral centre, between January 2009 and August 2016. Simultaneous bilateral AVS was performed before and after cosyntropin administration. We implemented immunohistochemistry for aldosterone synthase (CYP11B2) and 17α-hydroxylase/17,20 lyase (CYP17A1) in adrenal glands resected from patients without improvement of PA after surgical treatment and from those with limitations in AVS interpretation. RESULTS Of 55 patients who underwent adrenalectomy, three (5.5%) had no improvement of PA. All three patients underwent partial adrenalectomy to remove a CT-detected nodule present on the same side with AVS lateralization. Immunohistochemistry revealed a CYP11B2-negative nodule in both cases available. All patients who underwent total adrenalectomy based on AVS lateralization benefitted from surgery, including three patients with unilateral unsuccessful AVS and aldosterone suppression in the catheterized side vs inferior vena cava. CONCLUSIONS Radiographically identified adrenal nodules are not always a source of PA, even when ipsilateral with AVS lateralization. These data caution against reliance on imaging findings, either alone or in conjunction with AVS, to guide surgery for PA.
Collapse
|
50
|
Favorable surgical outcomes of aldosterone-producing adenoma based on lateralization by CT imaging and hypokalemia: a non-AVS-based strategy. Int Urol Nephrol 2017; 49:2151-2156. [PMID: 28918446 DOI: 10.1007/s11255-017-1705-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2017] [Accepted: 09/11/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE To test the efficacy of a strategy based on CT imaging and clinical characteristics on lateralizing origin of excess aldosterone secretion in primary aldosteronism. PATIENTS AND METHODS Consecutive patients with diagnosed primary hyperaldosteronism from June 2006 to July 2012 in our center underwent adrenal surgeries without pre-operational adrenal venous sampling (AVS) if all the three criteria were met: (1) round- or oval-shaped occupational lesion of low density after contrast enhancement with diameter >1 cm on CT scan was located in one adrenal gland; (2) unequivocally normal contralateral adrenal gland; (3) serum potassium level lower than 3.5 mmol/L. Subjects who had received operation were taken into analysis and follow-ups. RESULTS One hundred and twenty-five patients fulfilled the criteria and were recruited into our research. One hundred and twenty-two operated patients (97.6%) experienced complete resolution of hypokalemia as well as resolution or improvement in hypertension with reduction in antihypertensive medication, while 3 patients (2.4%) failed to obtain normal kalemia and continued on spironolactone therapy. At a median of 65-month (range 21-93) follow-up of these 122 subjects, 27 patients dropped out (22.1%). The 95 responding patients reported no episodes of paralysis or confirmed hypokalemia or any supplementation of potassium. Multivariate linear correlation analysis showed that plasma potassium level was correlated inversely with tumor diameter (r = -0.258, 95% CI -0.076, -0.514, p = 0.037) and basal plasma aldosterone level (r = -0.251, 95% CI -0.040, -0.464, p = 0.042). CONCLUSIONS Most patients with typical unilateral adrenal macroadenomas, normal contralateral glands and hypokalemia could attain favorable surgical therapeutic outcomes without pre-operational AVS lateralization.
Collapse
|