Importance of contralateral aldosterone suppression during adrenal vein sampling in the subtype evaluation of primary aldosteronism

Hironobu Umakoshi, Kanako Tanase-Nakao, Norio Wada, Takamasa Ichijo, Masakatsu Sone, Nobuya Inagaki, Takuyuki Katabami, Kohei Kamemura, Yuichi Matsuda, Yuichi Fujii, Tatsuya Kai, Tomikazu Fukuoka, Ryuichi Sakamoto, Atsushi Ogo, Tomoko Suzuki, Mika Tsuiki, Akira Shimatsu, Mitsuhide Naruse

Research output: Contribution to journalArticle

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Abstract

Objectives Adrenal vein sampling (AVS) is the standard criterion for the subtype diagnosis in primary aldosteronism (PA). Although lateralized index (LI) ≥4 after cosyntropin stimulation is the commonly recommended cut-off for unilateral aldosterone hypersecretion, many of the referral centres in the world use LI cut-off of <4 without sufficient evidence for its diagnostic accuracy. Aim The aim of the study was to establish the diagnostic significance of contralateral (CL) aldosterone suppression for the subtype diagnosis in patients with LI <4 in AVS. Design and patients A retrospective multicentre study was conducted in Japan. Of 124 PA patients subjected to unilateral adrenalectomy after successful AVS with cosyntropin administration, 29 patients with LI < 4 were included in the study. The patients were divided into Group A with CL suppression (n = 16) and Group B (n = 13) without CL suppression. Three outcome indices were assessed after 6 months postoperatively: normalization/significant improvement of hypertension, normalization of the aldosterone to renin ratio (ARR) and normalization of hypokalaemia. Results The normalization/significant improvement of hypertension was 81% in Group A and 54% in Group B (P = 0·2). The normalization of ARR was 100% in Group A and 46% in Group B (P = 0·004). Hypokalaemia was normalized in all patients of both groups. The overall cure rate of PA based on meeting all the three criteria was 81% in Group A and 31% in Group B (P = 0·01). Conclusions In patients with PA, where the LI is <4 on AVS, CL suppression of aldosterone is an accurate predictor of a unilateral source of aldosterone excess. CL suppression data should be interpreted in conjunction with computed tomographic adrenal imaging findings to guide surgical management.

Original languageEnglish
Pages (from-to)462-467
Number of pages6
JournalClinical Endocrinology
Volume83
Issue number4
DOIs
Publication statusPublished - Oct 1 2015
Externally publishedYes

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Hyperaldosteronism
Aldosterone
Veins
Cosyntropin
Hypokalemia
Renin
Hypertension
Adrenalectomy
Multicenter Studies
Japan
Referral and Consultation
Retrospective Studies

All Science Journal Classification (ASJC) codes

  • Endocrinology, Diabetes and Metabolism
  • Endocrinology

Cite this

Importance of contralateral aldosterone suppression during adrenal vein sampling in the subtype evaluation of primary aldosteronism. / Umakoshi, Hironobu; Tanase-Nakao, Kanako; Wada, Norio; Ichijo, Takamasa; Sone, Masakatsu; Inagaki, Nobuya; Katabami, Takuyuki; Kamemura, Kohei; Matsuda, Yuichi; Fujii, Yuichi; Kai, Tatsuya; Fukuoka, Tomikazu; Sakamoto, Ryuichi; Ogo, Atsushi; Suzuki, Tomoko; Tsuiki, Mika; Shimatsu, Akira; Naruse, Mitsuhide.

In: Clinical Endocrinology, Vol. 83, No. 4, 01.10.2015, p. 462-467.

Research output: Contribution to journalArticle

Umakoshi, H, Tanase-Nakao, K, Wada, N, Ichijo, T, Sone, M, Inagaki, N, Katabami, T, Kamemura, K, Matsuda, Y, Fujii, Y, Kai, T, Fukuoka, T, Sakamoto, R, Ogo, A, Suzuki, T, Tsuiki, M, Shimatsu, A & Naruse, M 2015, 'Importance of contralateral aldosterone suppression during adrenal vein sampling in the subtype evaluation of primary aldosteronism', Clinical Endocrinology, vol. 83, no. 4, pp. 462-467. https://doi.org/10.1111/cen.12761
Umakoshi, Hironobu ; Tanase-Nakao, Kanako ; Wada, Norio ; Ichijo, Takamasa ; Sone, Masakatsu ; Inagaki, Nobuya ; Katabami, Takuyuki ; Kamemura, Kohei ; Matsuda, Yuichi ; Fujii, Yuichi ; Kai, Tatsuya ; Fukuoka, Tomikazu ; Sakamoto, Ryuichi ; Ogo, Atsushi ; Suzuki, Tomoko ; Tsuiki, Mika ; Shimatsu, Akira ; Naruse, Mitsuhide. / Importance of contralateral aldosterone suppression during adrenal vein sampling in the subtype evaluation of primary aldosteronism. In: Clinical Endocrinology. 2015 ; Vol. 83, No. 4. pp. 462-467.
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abstract = "Objectives Adrenal vein sampling (AVS) is the standard criterion for the subtype diagnosis in primary aldosteronism (PA). Although lateralized index (LI) ≥4 after cosyntropin stimulation is the commonly recommended cut-off for unilateral aldosterone hypersecretion, many of the referral centres in the world use LI cut-off of <4 without sufficient evidence for its diagnostic accuracy. Aim The aim of the study was to establish the diagnostic significance of contralateral (CL) aldosterone suppression for the subtype diagnosis in patients with LI <4 in AVS. Design and patients A retrospective multicentre study was conducted in Japan. Of 124 PA patients subjected to unilateral adrenalectomy after successful AVS with cosyntropin administration, 29 patients with LI < 4 were included in the study. The patients were divided into Group A with CL suppression (n = 16) and Group B (n = 13) without CL suppression. Three outcome indices were assessed after 6 months postoperatively: normalization/significant improvement of hypertension, normalization of the aldosterone to renin ratio (ARR) and normalization of hypokalaemia. Results The normalization/significant improvement of hypertension was 81{\%} in Group A and 54{\%} in Group B (P = 0·2). The normalization of ARR was 100{\%} in Group A and 46{\%} in Group B (P = 0·004). Hypokalaemia was normalized in all patients of both groups. The overall cure rate of PA based on meeting all the three criteria was 81{\%} in Group A and 31{\%} in Group B (P = 0·01). Conclusions In patients with PA, where the LI is <4 on AVS, CL suppression of aldosterone is an accurate predictor of a unilateral source of aldosterone excess. CL suppression data should be interpreted in conjunction with computed tomographic adrenal imaging findings to guide surgical management.",
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T1 - Importance of contralateral aldosterone suppression during adrenal vein sampling in the subtype evaluation of primary aldosteronism

AU - Umakoshi, Hironobu

AU - Tanase-Nakao, Kanako

AU - Wada, Norio

AU - Ichijo, Takamasa

AU - Sone, Masakatsu

AU - Inagaki, Nobuya

AU - Katabami, Takuyuki

AU - Kamemura, Kohei

AU - Matsuda, Yuichi

AU - Fujii, Yuichi

AU - Kai, Tatsuya

AU - Fukuoka, Tomikazu

AU - Sakamoto, Ryuichi

AU - Ogo, Atsushi

AU - Suzuki, Tomoko

AU - Tsuiki, Mika

AU - Shimatsu, Akira

AU - Naruse, Mitsuhide

PY - 2015/10/1

Y1 - 2015/10/1

N2 - Objectives Adrenal vein sampling (AVS) is the standard criterion for the subtype diagnosis in primary aldosteronism (PA). Although lateralized index (LI) ≥4 after cosyntropin stimulation is the commonly recommended cut-off for unilateral aldosterone hypersecretion, many of the referral centres in the world use LI cut-off of <4 without sufficient evidence for its diagnostic accuracy. Aim The aim of the study was to establish the diagnostic significance of contralateral (CL) aldosterone suppression for the subtype diagnosis in patients with LI <4 in AVS. Design and patients A retrospective multicentre study was conducted in Japan. Of 124 PA patients subjected to unilateral adrenalectomy after successful AVS with cosyntropin administration, 29 patients with LI < 4 were included in the study. The patients were divided into Group A with CL suppression (n = 16) and Group B (n = 13) without CL suppression. Three outcome indices were assessed after 6 months postoperatively: normalization/significant improvement of hypertension, normalization of the aldosterone to renin ratio (ARR) and normalization of hypokalaemia. Results The normalization/significant improvement of hypertension was 81% in Group A and 54% in Group B (P = 0·2). The normalization of ARR was 100% in Group A and 46% in Group B (P = 0·004). Hypokalaemia was normalized in all patients of both groups. The overall cure rate of PA based on meeting all the three criteria was 81% in Group A and 31% in Group B (P = 0·01). Conclusions In patients with PA, where the LI is <4 on AVS, CL suppression of aldosterone is an accurate predictor of a unilateral source of aldosterone excess. CL suppression data should be interpreted in conjunction with computed tomographic adrenal imaging findings to guide surgical management.

AB - Objectives Adrenal vein sampling (AVS) is the standard criterion for the subtype diagnosis in primary aldosteronism (PA). Although lateralized index (LI) ≥4 after cosyntropin stimulation is the commonly recommended cut-off for unilateral aldosterone hypersecretion, many of the referral centres in the world use LI cut-off of <4 without sufficient evidence for its diagnostic accuracy. Aim The aim of the study was to establish the diagnostic significance of contralateral (CL) aldosterone suppression for the subtype diagnosis in patients with LI <4 in AVS. Design and patients A retrospective multicentre study was conducted in Japan. Of 124 PA patients subjected to unilateral adrenalectomy after successful AVS with cosyntropin administration, 29 patients with LI < 4 were included in the study. The patients were divided into Group A with CL suppression (n = 16) and Group B (n = 13) without CL suppression. Three outcome indices were assessed after 6 months postoperatively: normalization/significant improvement of hypertension, normalization of the aldosterone to renin ratio (ARR) and normalization of hypokalaemia. Results The normalization/significant improvement of hypertension was 81% in Group A and 54% in Group B (P = 0·2). The normalization of ARR was 100% in Group A and 46% in Group B (P = 0·004). Hypokalaemia was normalized in all patients of both groups. The overall cure rate of PA based on meeting all the three criteria was 81% in Group A and 31% in Group B (P = 0·01). Conclusions In patients with PA, where the LI is <4 on AVS, CL suppression of aldosterone is an accurate predictor of a unilateral source of aldosterone excess. CL suppression data should be interpreted in conjunction with computed tomographic adrenal imaging findings to guide surgical management.

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