Hironobu Umakoshi1, Norio Wada2, Takamasa Ichijo3, Kohei Kamemura4, Yuichi Matsuda5, Yuichi Fuji6, Tatsuya Kai7, Tomikazu Fukuoka8, Ryuichi Sakamoto9, Atsushi Ogo9, Tomoko Suzuki10, Mika Tsuiki1, Mitsuhide Naruse1. 1. Department of Endocrinology, Metabolism, and Hypertension, Clinical Research Institute, National Hospital Organisation Kyoto Medical Centre, 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 Cardiology, Akashi Medical Centre, Akashi, Japan. 5. Department of Cardiology, Sanda City Hospital, Sanda, Japan. 6. Department of Cardiology, Hiroshima General Hospital of West Japan Railway Company, Hiroshima, Japan. 7. Department of Cardiology, Saiseikai Tondabayashi Hospital, Tondabayashi, Japan. 8. Department of Internal Medicine, Matsuyama Red Cross Hospital, Matsuyama, Japan. 9. Department of Endocrinology and Metabolism, National Hospital Organisation, Kyushu Medical Centre, Fukuoka, Japan. 10. Department of Public Health, Kitasato University School of Medicine, Tokyo, Japan.
Abstract
CONTEXT: Although adrenal vein sampling (AVS) is the standard method for subtype diagnosis in primary aldosteronism (PA), protocol details including the sampling position in the adrenal vein are not standardized. OBJECTIVE: To establish the optimum sampling position in the left adrenal vein based on postoperative outcome in PA patients. DESIGN AND SETTING: Retrospective study in nine referral centres. PARTICIPANTS: Of 496 consecutive PA patients who underwent AVS between 2006 and 2013, 217 with successful AVS under cosyntropin stimulation, and with concomitant data from two positions: proximal (common trunk) and distal (central vein) to the junction with the inferior phrenic vein, were included. MAIN OUTCOME MEASURES: Discordant rate of subtype diagnosis between common trunk and central vein, and postoperative outcomes in patients with discordant results. RESULTS: Subtype diagnosis using common trunk and central vein was discordant in 10 (4·6%) of the 217 patients (κ = 0·87, P < 0·05). Of these 10 patients, eight with left unilateral subtype and two with bilateral subtype using common trunk data showed bilateral subtype and unilateral subtype, respectively, using central vein data. Five patients with left unilateral subtype and one with bilateral subtype by common trunk data underwent unilateral adrenalectomy. All six patients were cured of PA after adrenalectomy, resulting in false-negative rates of 17% (1/6) by common trunk data, and 83% (5/6) by central vein data. CONCLUSION: In view of its better potential diagnostic accuracy, technical ease, lower cost and lower risk of vein rupture, blood sampling from the common trunk of the left adrenal vein may be preferable as the standard method of AVS in patients with PA, although additional studies in a larger number of cases are required.
CONTEXT: Although adrenal vein sampling (AVS) is the standard method for subtype diagnosis in primary aldosteronism (PA), protocol details including the sampling position in the adrenal vein are not standardized. OBJECTIVE: To establish the optimum sampling position in the left adrenal vein based on postoperative outcome in PA patients. DESIGN AND SETTING: Retrospective study in nine referral centres. PARTICIPANTS: Of 496 consecutive PA patients who underwent AVS between 2006 and 2013, 217 with successful AVS under cosyntropin stimulation, and with concomitant data from two positions: proximal (common trunk) and distal (central vein) to the junction with the inferior phrenic vein, were included. MAIN OUTCOME MEASURES: Discordant rate of subtype diagnosis between common trunk and central vein, and postoperative outcomes in patients with discordant results. RESULTS: Subtype diagnosis using common trunk and central vein was discordant in 10 (4·6%) of the 217 patients (κ = 0·87, P < 0·05). Of these 10 patients, eight with left unilateral subtype and two with bilateral subtype using common trunk data showed bilateral subtype and unilateral subtype, respectively, using central vein data. Five patients with left unilateral subtype and one with bilateral subtype by common trunk data underwent unilateral adrenalectomy. All six patients were cured of PA after adrenalectomy, resulting in false-negative rates of 17% (1/6) by common trunk data, and 83% (5/6) by central vein data. CONCLUSION: In view of its better potential diagnostic accuracy, technical ease, lower cost and lower risk of vein rupture, blood sampling from the common trunk of the left adrenal vein may be preferable as the standard method of AVS in patients with PA, although additional studies in a larger number of cases are required.
Authors: K Kamemura; N Wada; T Ichijo; Y Matsuda; Y Fujii; T Kai; T Fukuoka; R Sakamoto; A Ogo; T Suzuki; H Umakoshi; M Tsuiki; M Naruse Journal: J Hum Hypertens Date: 2016-09-01 Impact factor: 3.012
Authors: N Wada; Y Shibayama; H Umakoshi; T Ichijo; Y Fujii; K Kamemura; T Kai; R Sakamoto; A Ogo; Y Matsuda; T Fukuoka; M Tsuiki; T Suzuki; M Naruse Journal: J Hum Hypertens Date: 2017-05-25 Impact factor: 3.012