Eleftheria Gkaniatsa1,2, Augustinas Sakinis3, Magnus Palmér3, Andreas Muth4, Penelope Trimpou1,2, Oskar Ragnarsson1,2. 1. Department of Internal Medicine and Clinical Nutrition, Institute of Medicine at Sahlgrenska Academy, University of Gothenburg, Sweden. 2. The Department of Endocrinology, Sahlgrenska University Hospital, Gothenburg, Sweden. 3. Department of Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden. 4. Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
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.
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.
Authors: Marta Araujo-Castro; Miguel Paja Fano; Marga González Boillos; Begoña Pla Peris; Eider Pascual-Corrales; Ana María García Cano; Paola Parra Ramírez; Patricia Martín Rojas-Marcos; Jorge Gabriel Ruiz-Sanchez; Almudena Vicente Delgado; Emilia Gómez Hoyos; Rui Ferreira; Iñigo García Sanz; Mònica Recasens Sala; Rebeca Barahona San Millan; María José Picón César; Patricia Díaz Guardiola; Juan Jesús García González; Carolina M Perdomo; Laura Manjón Miguélez; Rogelio García Centeno; Juan Carlos Percovich; Ángel Rebollo Román; Paola Gracia Gimeno; Cristina Robles Lázaro; Manuel Morales-Ruiz; Felicia A Hanzu Journal: Endocrine Date: 2022-06-25 Impact factor: 3.925