Hironobu Umakoshi1, Kanako Tanase-Nakao1, Norio Wada2, Takamasa Ichijo3, Masakatsu Sone4, Nobuya Inagaki4, Takuyuki Katabami5, Kohei Kamemura6, Yuichi Matsuda7, Yuichi Fujii8, Tatsuya Kai9, Tomikazu Fukuoka10, Ryuichi Sakamoto11, Atsushi Ogo11, Tomoko Suzuki12, Mika Tsuiki1, Akira Shimatsu1, Mitsuhide Naruse1. 1. Department of Endocrinology, Metabolism, and Hypertension, National Hospital Organization Kyoto Medical Center, Kyoto, Japan. 2. Department of Diabetes and Endocrinology, Sapporo City Hospital, Sapporo, Japan. 3. Department of Diabetes and Endocrinology, Saiseikai Yokohama City Toubu Hospital, Yokohama, Japan. 4. Department of Diabetes, Endocrinology, and Nutrition, Kyoto University Graduate School of Medicine, Kyoto, Japan. 5. Department of Endocrinology and Metabolism, Yokohama City Seibu Hospital, St. Marianna University School of Medicine, Yokohama, Japan. 6. Department of Cardiology, Akashi Medical Center, Akashi, Japan. 7. Department of Cardiology, Sanda City Hospital, Sanda, Japan. 8. Department of Cardiology, Hiroshima General Hospital of West Japan Railway Company, Hiroshima, Japan. 9. Department of Cardiology, Saiseikai Tondabayashi Hospital, Tondabayashi, Japan. 10. Department of Internal Medicine, Matsuyama Red Cross Hospital, Matsuyama, Japan. 11. Department of Endocrinology and Metabolism, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan. 12. Department of Public Health, Kitasato University School of Medicine, Tokyo, Japan.
Abstract
OBJECTIVES: Adrenal vein sampling (AVS) is the standard criterion for the subtype diagnosis in primary aldosteronism (PA). Although lateralized index (LI) ≥4 after cosyntropin stimulation is the commonly recommended cut-off for unilateral aldosterone hypersecretion, many of the referral centres in the world use LI cut-off of <4 without sufficient evidence for its diagnostic accuracy. AIM: The aim of the study was to establish the diagnostic significance of contralateral (CL) aldosterone suppression for the subtype diagnosis in patients with LI <4 in AVS. DESIGN AND PATIENTS: A retrospective multicentre study was conducted in Japan. Of 124 PA patients subjected to unilateral adrenalectomy after successful AVS with cosyntropin administration, 29 patients with LI < 4 were included in the study. The patients were divided into Group A with CL suppression (n = 16) and Group B (n = 13) without CL suppression. Three outcome indices were assessed after 6 months postoperatively: normalization/significant improvement of hypertension, normalization of the aldosterone to renin ratio (ARR) and normalization of hypokalaemia. RESULTS: The normalization/significant improvement of hypertension was 81% in Group A and 54% in Group B (P = 0·2). The normalization of ARR was 100% in Group A and 46% in Group B (P = 0·004). Hypokalaemia was normalized in all patients of both groups. The overall cure rate of PA based on meeting all the three criteria was 81% in Group A and 31% in Group B (P = 0·01). CONCLUSIONS: In patients with PA, where the LI is <4 on AVS, CL suppression of aldosterone is an accurate predictor of a unilateral source of aldosterone excess. CL suppression data should be interpreted in conjunction with computed tomographic adrenal imaging findings to guide surgical management.
OBJECTIVES: Adrenal vein sampling (AVS) is the standard criterion for the subtype diagnosis in primary aldosteronism (PA). Although lateralized index (LI) ≥4 after cosyntropin stimulation is the commonly recommended cut-off for unilateral aldosterone hypersecretion, many of the referral centres in the world use LI cut-off of <4 without sufficient evidence for its diagnostic accuracy. AIM: The aim of the study was to establish the diagnostic significance of contralateral (CL) aldosterone suppression for the subtype diagnosis in patients with LI <4 in AVS. DESIGN AND PATIENTS: A retrospective multicentre study was conducted in Japan. Of 124 PA patients subjected to unilateral adrenalectomy after successful AVS with cosyntropin administration, 29 patients with LI < 4 were included in the study. The patients were divided into Group A with CL suppression (n = 16) and Group B (n = 13) without CL suppression. Three outcome indices were assessed after 6 months postoperatively: normalization/significant improvement of hypertension, normalization of the aldosterone to renin ratio (ARR) and normalization of hypokalaemia. RESULTS: The normalization/significant improvement of hypertension was 81% in Group A and 54% in Group B (P = 0·2). The normalization of ARR was 100% in Group A and 46% in Group B (P = 0·004). Hypokalaemia was normalized in all patients of both groups. The overall cure rate of PA based on meeting all the three criteria was 81% in Group A and 31% in Group B (P = 0·01). CONCLUSIONS: In patients with PA, where the LI is <4 on AVS, CL suppression of aldosterone is an accurate predictor of a unilateral source of aldosterone excess. CL suppression data should be interpreted in conjunction with computed tomographic adrenal imaging findings to guide surgical management.
Authors: Aya T Nanba; Kazutaka Nanba; James B Byrd; James J Shields; Thomas J Giordano; Barbara S Miller; William E Rainey; Richard J Auchus; Adina F Turcu Journal: Clin Endocrinol (Oxf) Date: 2017-09-04 Impact factor: 3.478
Authors: Min-On Tan; Troy Hai Kiat Puar; Saravana Kumar Swaminathan; Yu-Kwang Donovan Tay; Tar Choon Aw; David Yurui Lim; Haiyuan Shi; Lily Mae Quevedo Dacay; Meifen Zhang; Joan Joo Ching Khoo; Keng Sin Ng Journal: Singapore Med J Date: 2020-12-02 Impact factor: 3.331
Authors: Ye Seul Yang; Seung Hun Lee; Jung Hee Kim; Jee Hee Yoo; Jung Hyun Lee; Seo Young Lee; A Ram Hong; Dong-Hwa Lee; Jung-Min Koh; Jae Hyeon Kim; Sang Wan Kim Journal: Endocrinol Metab (Seoul) Date: 2021-08-11