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Multifocal, Asymmetric Bilateral Primary Aldosteronism Cannot be Excluded by Strong Adrenal Vein Sampling Lateralization: An International Retrospective Cohort Study.
Turcu, Adina F; Tezuka, Yuta; Lim, Jung Soo; Salman, Zara; Sehgal, Kartik; Liu, Haiping; Larose, Stéphanie; Parksook, Wasita Warachit; Williams, Tracy Ann; Cohen, Debbie L; Wachtel, Heather; Zhang, Jinghong; Dorwal, Pranav; Satoh, Fumitoshi; Yang, Jun; Lacroix, André; Reincke, Martin; Giordano, Tom J; Udager, Aaron M; Vaidya, Anand; Rainey, William E.
Afiliación
  • Turcu AF; Division of Metabolism, Endocrinology, and Diabetes (A.F.T., Z.S., H.L.), University of Michigan, Ann Arbor.
  • Tezuka Y; Division of Nephrology, Endocrinology and Vascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan (Y.T., F.S.).
  • Lim JS; Division of Endocrinology and Metabolism, Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju Severance Christian Hospital, South Korea (J.S.L.).
  • Salman Z; Division of Metabolism, Endocrinology, and Diabetes (A.F.T., Z.S., H.L.), University of Michigan, Ann Arbor.
  • Sehgal K; Department of Medicine, Centre for Endocrinology and Metabolism (K.S., J.Z., J.Y.), Hudson Institute of Medical Research, Clayton, VIC, Australia.
  • Liu H; Division of Metabolism, Endocrinology, and Diabetes (A.F.T., Z.S., H.L.), University of Michigan, Ann Arbor.
  • Larose S; Division of Endocrinology, Department of Medicine and Research Center, Centre hospitalier de l'Université de Montréal, Québec, Canada (S.L., A.L.).
  • Parksook WW; Center for Adrenal Disorders, Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (W.W.P., A.V.).
  • Williams TA; Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, LMU München, Germany (T.A.W., M.R.).
  • Cohen DL; Renal-Electrolyte and Hypertension Division (D.L.C.), Perelman School of Medicine, University of Pennsylvania, Philadelphia.
  • Wachtel H; Department of Surgery (H.W.), Perelman School of Medicine, University of Pennsylvania, Philadelphia.
  • Zhang J; Department of Medicine, Centre for Endocrinology and Metabolism (K.S., J.Z., J.Y.), Hudson Institute of Medical Research, Clayton, VIC, Australia.
  • Dorwal P; Department of Pathology (P.D.), Hudson Institute of Medical Research, Clayton, VIC, Australia.
  • Satoh F; Division of Nephrology, Endocrinology and Vascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan (Y.T., F.S.).
  • Yang J; Department of Medicine, Centre for Endocrinology and Metabolism (K.S., J.Z., J.Y.), Hudson Institute of Medical Research, Clayton, VIC, Australia.
  • Lacroix A; Division of Endocrinology, Department of Medicine and Research Center, Centre hospitalier de l'Université de Montréal, Québec, Canada (S.L., A.L.).
  • Reincke M; Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, LMU München, Germany (T.A.W., M.R.).
  • Giordano TJ; Department of Pathology (T.J.G., A.M.U.), University of Michigan, Ann Arbor.
  • Udager AM; Department of Pathology (T.J.G., A.M.U.), University of Michigan, Ann Arbor.
  • Vaidya A; Center for Adrenal Disorders, Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (W.W.P., A.V.).
  • Rainey WE; Department of Molecular and Integrative Physiology (W.E.R.), University of Michigan, Ann Arbor.
Hypertension ; 81(3): 604-613, 2024 Mar.
Article en En | MEDLINE | ID: mdl-38174562
ABSTRACT

BACKGROUND:

Primary aldosteronism (PA) has been broadly dichotomized into unilateral and bilateral forms. Adrenal vein sampling (AVS) lateralization indices (LI) ≥2 to 4 are the standard-of-care to recommend unilateral adrenalectomy for presumed unilateral PA. We aimed to assess the rates and characteristics of residual PA after AVS-guided adrenalectomy.

METHODS:

We conducted an international, retrospective, cohort study of patients with PA from 7 referral centers who underwent unilateral adrenalectomy based on LI≥4 on baseline and/or cosyntropin-stimulated AVS. Aldosterone synthase (CYP11B2) immunohistochemistry and next generation sequencing were performed on available formalin-fixed paraffin-embedded adrenal tissue.

RESULTS:

The cohort included 283 patients who underwent AVS-guided adrenalectomy, followed for a median of 326 days postoperatively. Lack of PA cure was observed in 16% of consecutive patients, and in 22 patients with lateralized PA on both baseline and cosyntropin-stimulated AVS. Among patients with residual PA postoperatively, 73% had multiple CYP11B2 positive areas within the resected adrenal tissue (versus 23% in those cured), wherein CACNA1D mutations were most prevalent (63% versus 33% in those cured). In adjusted regression models, independent predictors of postoperative residual PA included Black versus White race (odds ratio, 5.10 [95% CI, 1.45-17.86]), AVS lateralization only at baseline (odds ratio, 8.93 [95% CI 3.00-26.32] versus both at baseline and after cosyntropin stimulation), and CT-AVS disagreement (odds ratio, 2.75 [95% CI, 1.20-6.31]).

CONCLUSIONS:

Multifocal, asymmetrical bilateral PA is relatively common, and it cannot be excluded by robust AVS lateralization. Long-term postoperative monitoring should be routinely pursued, to identify residual PA and afford timely initiation of targeted medical therapy.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Hiperaldosteronismo Tipo de estudio: Diagnostic_studies / Etiology_studies / Incidence_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Humans Idioma: En Revista: Hypertension Año: 2024 Tipo del documento: Article Pais de publicación: Estados Unidos
Texto completo
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Hiperaldosteronismo Tipo de estudio: Diagnostic_studies / Etiology_studies / Incidence_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Humans Idioma: En Revista: Hypertension Año: 2024 Tipo del documento: Article Pais de publicación: Estados Unidos