Clinical outcomes of primary aldosteronism based on lateralization index and contralateral suppression index after adrenal venous sampling in real-world practice: a retrospective cohort study

Jeongmin Lee,Dong-Jun Lim,Moo Il Kang,Byungil Choi,Min-Hee Kim,Borami Kang,Jeonghoon Ha,Tae-Ho Hong

doi:10.1186/s12902-020-00591-8

Jeongmin Lee, Dong-Jun Lim + Show 6 more

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https://doi.org/10.1186/s12902-020-00591-8

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Abstract

BackgroundWe investigated whether the contralateral suppression index in aldosterone-producing adrenal adenoma could be used as a diagnostic criterion when catheterization in either right or left adrenal vein fails or when a discrepancy in the adrenal vein sampling (AVS) results and imaging findings occurs in the real-world practice.MethodsWe retrospectively reviewed 48 patients who had resistant hypertension (HTN) or hypokalemia with a biochemical diagnosis of primary aldosteronism and who underwent AVS from January 2009 to June 2017 at a tertiary referral hospital. Selection index (SI), lateralization index (LI), and contralateral suppression index (CSI) were calculated based on AVS results and the final clinical outcomes were evaluated.ResultsThe catheterization of both adrenal veins was successful in 43 of 48 (89.6%) patients. The lateralization based only on LI was performed in 23 out of 43 (53.5%) patients. When CSI and LI were combined in decision making, the concordance between adrenal computed tomography scan and AVS for unilateral lesion improved from 59.3% (19/32) to 75.0% (24/32). CSI also correlated well with unilateral adrenal disease in the catheterization failure group. The final outcomes of HTN were better in the contralateral suppression group.ConclusionCSI combined with LI could be a supplementary diagnostic tool in patients with non-lateralization or catheterization failure and predict the clinical outcomes of HTN in patients with primary aldosteronism.

Highlights

We investigated whether the contralateral suppression index in aldosterone-producing adrenal adenoma could be used as a diagnostic criterion when catheterization in either right or left adrenal vein fails or when a discrepancy in the adrenal vein sampling (AVS) results and imaging findings occurs in the real-world practice
The clinical practice guidelines of the Endocrine Society recommend adrenal computed tomography (CT) scan as the initial diagnostic imaging for classification of subtype after Primary aldosteronism (PA) is screened with plasma aldosterone/renin ratio (ARR) [4]
Clinicians are often faced with conflicting results when conducting Adrenal vein sampling (AVS) and adrenal CT scan to differentiate between Aldosterone-producing adrenal adenoma (APA) and bilateral idiopathic adrenal hyperplasia (BAH)

Summary

Introduction

We investigated whether the contralateral suppression index in aldosterone-producing adrenal adenoma could be used as a diagnostic criterion when catheterization in either right or left adrenal vein fails or when a discrepancy in the adrenal vein sampling (AVS) results and imaging findings occurs in the real-world practice. PA is caused by inappropriately high synthesis and secretion of aldosterone leading to high plasma sodium retention, suppression of plasma renin, and increased potassium excretion. These conditions lead to arterial HTN and hypokalemia. Adrenal vein sampling (AVS) should be performed when surgery is decided to distinguish between unilateral and bilateral adrenal diseases This procedure is invasive and difficult to perform; The success rate of both adrenal veins catheterization was presented in a various range (42– 98%) [5].

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