Hironobu Umakoshi1, Tatsuki Ogasawara1, Yoshiyu Takeda2, Isao Kurihara3, Hiroshi Itoh3, Takuyuki Katabami4, Takamasa Ichijo5, Norio Wada6, Yui Shibayama6, Takanobu Yoshimoto7, Yoshihiro Ogawa7, Junji Kawashima8, Masakatsu Sone9, Nobuya Inagaki9, Katsutoshi Takahashi10, Minemori Watanabe11, Yuichi Matsuda12, Hiroki Kobayashi13, Hirotaka Shibata14, Kohei Kamemura15, Michio Otsuki16, Yuichi Fujii17, Koichi Yamamto18, Atsushi Ogo19, Toshihiko Yanase20, Shintaro Okamura21, Shozo Miyauchi22, Tomoko Suzuki23, Mika Tsuiki1, Mitsuhide Naruse1. 1. Department of Endocrinology and Metabolism, National Hospital Organization Kyoto Medical Center, Kyoto, Japan. 2. Department of Internal Medicine, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan. 3. Department of Endocrinology, Metabolism and Nephrology, School of Medicine, Keio University, Tokyo, Japan. 4. Division of Metabolism and Endocrinology, Department of Internal Medicine, St. Marianna University School of Medicine Yokohama City Seibu Hospital, Yokohama, Japan. 5. Department of Endocrinology and Metabolism, Saiseikai Yokohamashi Tobu Hospital, Yokohama, Japan. 6. Department of Diabetes and Endocrinology, Sapporo City General Hospital, Sapporo, Japan. 7. Department of Molecular Endocrinology and Metabolism, Tokyo Medical and Dental University, Tokyo, Japan. 8. Faculty of Life Science, Department of Metabolic Medicine, Kumamoto University, Kumamoto, Japan. 9. Department of Diabetes, Endocrinology and Nutrition, Kyoto University, Kyoto, Japan. 10. Division of Nephrology and Endocrinology, University of Tokyo School of Medicine, Tokyo, Japan. 11. Department of Endocrinology and Diabetes, Okazaki City Hospital, Okazaki, Japan. 12. Department of Cardiology, Sanda City Hospital, Sanda, Japan. 13. Division of Nephrology, Hypertension and Endocrinology, Nihon University School of Medicine, Tokyo, Japan. 14. Faculty of Medicine, Department of Endocrinology, Metabolism, Rheumatology and Nephrology, Oita University, Yufu, Japan. 15. Department of Cardiology, Akashi Medical Center, Akashi, Japan. 16. Department of Metabolic Medicine, Osaka University Graduate School of Medicine, Osaka, Japan. 17. Department of Cardiology, JR Hiroshima Hospital, Hiroshima, Japan. 18. Department of Geriatric and General Medicine, Osaka University Graduate School of Medicine, Osaka, Japan. 19. Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan. 20. Faculty of Medicine, Department of Endocrinology and Diabetes Mellitus, Fukuoka University, Fukuoka, Japan. 21. Department of Endocrinology and Metabolism, Tenriyorozu Hospital, Tenri, Nara, Japan. 22. Department of Internal Medicine, Uwajima City Hospital, Uwajima, Japan. 23. Department of Public Health, School of Medicine, International University of Health and Welfare, Narita, Japan.
Abstract
CONTEXT: The current Endocrine Society Guideline suggests that patients aged <35 years with marked primary aldosteronism (PA) and unilateral adrenal lesions on adrenal computed tomography (CT) scan may not need adrenal vein sampling (AVS) before proceeding to unilateral adrenalectomy. This suggestion is, however, based on the data from only one report in the literature. OBJECTIVE: We sought to determine the accuracy of CT findings in young PA patients who had unilateral adrenal disease on CT with hypokalaemia and elevation of aldosterone. DESIGN AND PATIENTS: We retrospectively studied 358 PA patients (n = 30, aged <35 years; n = 39, aged 35-40 years; n = 289, aged ≥40 years) with hypokalaemia and elevation of aldosterone and unilateral disease on CT who had successful AVS. MAIN OUTCOME MEASURE: Accuracy of CT findings is determined by AVS findings and/or surgical outcomes in patients aged <35 years. RESULTS: Concordance of the diagnosis between CT and AVS was 90% (27/30) in patients aged <35 years, 79% (31/39) in patients aged 35-40 years and 69% (198/289) in those aged ≥40 years (trend for P < .01). Surgical benefit was confirmed in three patients aged <35 years and in three patients aged 35-40 years with the available surgical data who had discordance between CT and AVS findings. Collectively, the diagnostic accuracy of CT findings was 100% (30/30) if aged <35 years and 87% (34/39) if aged 35-40 years. CONCLUSION: Primary aldosteronism patients aged <35 years with hypokalaemia and elevation of aldosterone and unilateral disease on adrenal CT could be spared AVS.
CONTEXT: The current Endocrine Society Guideline suggests that patients aged <35 years with marked primary aldosteronism (PA) and unilateral adrenal lesions on adrenal computed tomography (CT) scan may not need adrenal vein sampling (AVS) before proceeding to unilateral adrenalectomy. This suggestion is, however, based on the data from only one report in the literature. OBJECTIVE: We sought to determine the accuracy of CT findings in young PA patients who had unilateral adrenal disease on CT with hypokalaemia and elevation of aldosterone. DESIGN AND PATIENTS: We retrospectively studied 358 PA patients (n = 30, aged <35 years; n = 39, aged 35-40 years; n = 289, aged ≥40 years) with hypokalaemia and elevation of aldosterone and unilateral disease on CT who had successful AVS. MAIN OUTCOME MEASURE: Accuracy of CT findings is determined by AVS findings and/or surgical outcomes in patients aged <35 years. RESULTS: Concordance of the diagnosis between CT and AVS was 90% (27/30) in patients aged <35 years, 79% (31/39) in patients aged 35-40 years and 69% (198/289) in those aged ≥40 years (trend for P < .01). Surgical benefit was confirmed in three patients aged <35 years and in three patients aged 35-40 years with the available surgical data who had discordance between CT and AVS findings. Collectively, the diagnostic accuracy of CT findings was 100% (30/30) if aged <35 years and 87% (34/39) if aged 35-40 years. CONCLUSION: Primary aldosteronism patients aged <35 years with hypokalaemia and elevation of aldosterone and unilateral disease on adrenal CT could be spared AVS.
Authors: Davis Sam; Gregory A Kline; Benny So; Janice L Pasieka; Adrian Harvey; Alex Chin; Stefan J Przybojewski; Alexander A Leung Journal: J Clin Endocrinol Metab Date: 2021-01-23 Impact factor: 5.958
Authors: Seung Hun Lee; Jong Woo Kim; Hyun-Ki Yoon; Jung-Min Koh; Chan Soo Shin; Sang Wan Kim; Jung Hee Kim Journal: Endocrinol Metab (Seoul) Date: 2021-03-31
Authors: Seung Hun Lee; Jong Woo Kim; Hyun-Ki Yoon; Jung-Min Koh; Chan Soo Shin; Sang Wan Kim; Jung Hee Kim Journal: Endocrinol Metab (Seoul) Date: 2021-08-27
Authors: Davis Sam; Gregory A Kline; Benny So; Gregory L Hundemer; Janice L Pasieka; Adrian Harvey; Alex Chin; Stefan J Przybojewski; Cori E Caughlin; Alexander A Leung Journal: Am J Hypertens Date: 2022-04-02 Impact factor: 2.689