Consequences of adrenal venous sampling in primary hyperaldosteronism and predictors of unilateral adrenal disease

Aarti Mathur, Clinton D. Kemp, Utpal Dutta, Smita Baid, Alejandro Ayala, Richard E. Chang, Seth M. Steinberg, Vasilios Papademetriou, Eileen Lange, Steven K. Libutti, James F. Pingpank, H. Richard Alexander, Giao Q. Phan, Marybeth Hughes, W. Marston Linehan, Peter A. Pinto, Constantine A. Stratakis, Electron Kebebew

Research output: Contribution to journalArticle

37 Citations (Scopus)

Abstract

BACKGROUND: In patients with primary hyperaldosteronism, distinguishing between unilateral and bilateral adrenal hypersecretion is critical in assessing treatment options. Adrenal venous sampling (AVS) has been advocated by some to be the gold standard for localization of the responsible lesion, but there remains a lack of consensus for the criteria and the standardization of technique. STUDY DESIGN: We performed a retrospective study of 114 patients with a biochemical diagnosis of primary hyperaldosteronism who all underwent CT scan and AVS before and after corticotropin (ACTH) stimulation. Univariate and multivariate analyses were performed to determine what factors were associated with AVS lateralization, and which AVS values were the most accurate criteria for lateralization. RESULTS: Eighty-five patients underwent surgery at our institution for unilateral hyperaldosteronism. Of the 57 patients who demonstrated unilateral abnormalities on CT, AVS localized to the contralateral side in 5 patients and revealed bilateral hyperplasia in 6 patients. Of the 52 patients who showed bilateral disease on CT scan, 43 lateralized with AVS. The most accurate criterion on AVS for lateralization was the post-ACTH stimulation value. Factors associated with AVS lateralization included a low renin value, high plasma aldosterone-to plasma-renin ratio, and adrenal mass < 3 cm on CT scan. CONCLUSIONS: Because 50% of patients would have been inappropriately managed based on CT scan findings, patients with biochemical evidence of primary hyperaldosteronism and considering adrenalectomy should have AVS. The most accurate measurement for AVS lateralization was the post-ACTH stimulation value. Although several factors predict successful AVS lateralization, none are accurate enough to perform AVS selectively.

Original languageEnglish (US)
Pages (from-to)384-390
Number of pages7
JournalJournal of the American College of Surgeons
Volume211
Issue number3
DOIs
StatePublished - Sep 2010

Fingerprint

Hyperaldosteronism
Adrenocorticotropic Hormone
Renin
Adrenalectomy
Aldosterone
Hyperplasia
Multivariate Analysis
Retrospective Studies

Keywords

  • AC
  • ACTH
  • adrenal venous sampling
  • aldosterone-to-cortisol ratio
  • AVS
  • corticotropin
  • PAC
  • plasma aldosterone concentration
  • plasma renin activity
  • PRA

ASJC Scopus subject areas

  • Surgery

Cite this

Consequences of adrenal venous sampling in primary hyperaldosteronism and predictors of unilateral adrenal disease. / Mathur, Aarti; Kemp, Clinton D.; Dutta, Utpal; Baid, Smita; Ayala, Alejandro; Chang, Richard E.; Steinberg, Seth M.; Papademetriou, Vasilios; Lange, Eileen; Libutti, Steven K.; Pingpank, James F.; Alexander, H. Richard; Phan, Giao Q.; Hughes, Marybeth; Linehan, W. Marston; Pinto, Peter A.; Stratakis, Constantine A.; Kebebew, Electron.

In: Journal of the American College of Surgeons, Vol. 211, No. 3, 09.2010, p. 384-390.

Research output: Contribution to journalArticle

Mathur, A, Kemp, CD, Dutta, U, Baid, S, Ayala, A, Chang, RE, Steinberg, SM, Papademetriou, V, Lange, E, Libutti, SK, Pingpank, JF, Alexander, HR, Phan, GQ, Hughes, M, Linehan, WM, Pinto, PA, Stratakis, CA & Kebebew, E 2010, 'Consequences of adrenal venous sampling in primary hyperaldosteronism and predictors of unilateral adrenal disease', Journal of the American College of Surgeons, vol. 211, no. 3, pp. 384-390. https://doi.org/10.1016/j.jamcollsurg.2010.05.006
Mathur, Aarti ; Kemp, Clinton D. ; Dutta, Utpal ; Baid, Smita ; Ayala, Alejandro ; Chang, Richard E. ; Steinberg, Seth M. ; Papademetriou, Vasilios ; Lange, Eileen ; Libutti, Steven K. ; Pingpank, James F. ; Alexander, H. Richard ; Phan, Giao Q. ; Hughes, Marybeth ; Linehan, W. Marston ; Pinto, Peter A. ; Stratakis, Constantine A. ; Kebebew, Electron. / Consequences of adrenal venous sampling in primary hyperaldosteronism and predictors of unilateral adrenal disease. In: Journal of the American College of Surgeons. 2010 ; Vol. 211, No. 3. pp. 384-390.
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AU - Mathur, Aarti

AU - Kemp, Clinton D.

AU - Dutta, Utpal

AU - Baid, Smita

AU - Ayala, Alejandro

AU - Chang, Richard E.

AU - Steinberg, Seth M.

AU - Papademetriou, Vasilios

AU - Lange, Eileen

AU - Libutti, Steven K.

AU - Pingpank, James F.

AU - Alexander, H. Richard

AU - Phan, Giao Q.

AU - Hughes, Marybeth

AU - Linehan, W. Marston

AU - Pinto, Peter A.

AU - Stratakis, Constantine A.

AU - Kebebew, Electron

PY - 2010/9

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N2 - BACKGROUND: In patients with primary hyperaldosteronism, distinguishing between unilateral and bilateral adrenal hypersecretion is critical in assessing treatment options. Adrenal venous sampling (AVS) has been advocated by some to be the gold standard for localization of the responsible lesion, but there remains a lack of consensus for the criteria and the standardization of technique. STUDY DESIGN: We performed a retrospective study of 114 patients with a biochemical diagnosis of primary hyperaldosteronism who all underwent CT scan and AVS before and after corticotropin (ACTH) stimulation. Univariate and multivariate analyses were performed to determine what factors were associated with AVS lateralization, and which AVS values were the most accurate criteria for lateralization. RESULTS: Eighty-five patients underwent surgery at our institution for unilateral hyperaldosteronism. Of the 57 patients who demonstrated unilateral abnormalities on CT, AVS localized to the contralateral side in 5 patients and revealed bilateral hyperplasia in 6 patients. Of the 52 patients who showed bilateral disease on CT scan, 43 lateralized with AVS. The most accurate criterion on AVS for lateralization was the post-ACTH stimulation value. Factors associated with AVS lateralization included a low renin value, high plasma aldosterone-to plasma-renin ratio, and adrenal mass < 3 cm on CT scan. CONCLUSIONS: Because 50% of patients would have been inappropriately managed based on CT scan findings, patients with biochemical evidence of primary hyperaldosteronism and considering adrenalectomy should have AVS. The most accurate measurement for AVS lateralization was the post-ACTH stimulation value. Although several factors predict successful AVS lateralization, none are accurate enough to perform AVS selectively.

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KW - plasma renin activity

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