Aya T Nanba1, Kazutaka Nanba2, James B Byrd3, James J Shields4, Thomas J Giordano5, Barbara S Miller6, William E Rainey1,2, Richard J Auchus1,7, Adina F Turcu1. 1. Division of Metabolism, Endocrinology, and Diabetes, University of Michigan, Ann Arbor, MI, USA. 2. Department of Molecular and Integrative Physiology, University of Michigan, Ann Arbor, MI, USA. 3. Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI, USA. 4. Department of Radiology, University of Michigan, Ann Arbor, MI, USA. 5. Department of Pathology, University of Michigan, Ann Arbor, MI, USA. 6. Department of Surgery, University of Michigan, Ann Arbor, MI, USA. 7. Department of Pharmacology, University of Michigan, Ann Arbor, MI, USA.
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.
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.
Authors: Fiemu E Nwariaku; Barbra S Miller; Richard Auchus; Shelby Holt; Lori Watumull; Bart Dolmatch; Shawna Nesbitt; Wanpen Vongpatanasin; Ronald Victor; Frank Wians; Edward Livingston; William H Snyder Journal: Arch Surg Date: 2006-05
Authors: John W Funder; Robert M Carey; Franco Mantero; M Hassan Murad; Martin Reincke; Hirotaka Shibata; Michael Stowasser; William F Young Journal: J Clin Endocrinol Metab Date: 2016-03-02 Impact factor: 5.958
Authors: Kazutaka Nanba; Andrew X Chen; Kei Omata; Michelle Vinco; Thomas J Giordano; Tobias Else; Gary D Hammer; Scott A Tomlins; William E Rainey Journal: J Clin Endocrinol Metab Date: 2016-01-14 Impact factor: 5.958
Authors: Kazutaka Nanba; Amy R Blinder; Juilee Rege; Namita G Hattangady; Tobias Else; Chia-Jen Liu; Scott A Tomlins; Pankaj Vats; Chandan Kumar-Sinha; Thomas J Giordano; William E Rainey Journal: Hypertension Date: 2020-01-27 Impact factor: 10.190
Authors: Aya T Nanba; Taweesak Wannachalee; James J Shields; James B Byrd; William E Rainey; Richard J Auchus; Adina F Turcu Journal: J Clin Endocrinol Metab Date: 2019-02-01 Impact factor: 5.958
Authors: Taweesak Wannachalee; Lili Zhao; Kazutaka Nanba; Aya T Nanba; James J Shields; William E Rainey; Richard J Auchus; Adina F Turcu Journal: J Clin Endocrinol Metab Date: 2019-12-01 Impact factor: 5.958
Authors: Omair A Shariq; Kabir Mehta; Geoffrey B Thompson; Melanie L Lyden; David R Farley; Irina Bancos; Benzon M Dy; William F Young; Travis J McKenzie Journal: World J Surg Date: 2019-10 Impact factor: 3.352
Authors: Kazutaka Nanba; Kei Omata; Tobias Else; Peter C C Beck; Aya T Nanba; Adina F Turcu; Barbra S Miller; Thomas J Giordano; Scott A Tomlins; William E Rainey Journal: J Clin Endocrinol Metab Date: 2018-10-01 Impact factor: 5.958