Multifocal, Asymmetric Bilateral Primary Aldosteronism Cannot be Excluded by Strong Adrenal Vein Sampling Lateralization : An International Retrospective Cohort Study
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.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2024 |
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| Erschienen: |
2024 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:81 |
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| Enthalten in: |
Hypertension (Dallas, Tex. : 1979) - 81(2024), 3 vom: 01. März, Seite 604-613 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Turcu, Adina F [VerfasserIn] |
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| Links: |
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| Themen: |
16960-16-0 |
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| Anmerkungen: |
Date Completed 16.02.2024 Date Revised 10.03.2024 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1161/HYPERTENSIONAHA.123.21910 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM366651862 |
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| 100 | 1 | |a Turcu, Adina F |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Multifocal, Asymmetric Bilateral Primary Aldosteronism Cannot be Excluded by Strong Adrenal Vein Sampling Lateralization |b An International Retrospective Cohort Study |
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| 500 | |a Date Revised 10.03.2024 | ||
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| 500 | |a Citation Status MEDLINE | ||
| 520 | |a 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 | ||
| 520 | |a 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 | ||
| 520 | |a 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]) | ||
| 520 | |a 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 | ||
| 650 | 4 | |a Journal Article | |
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| 700 | 1 | |a Tezuka, Yuta |e verfasserin |4 aut | |
| 700 | 1 | |a Lim, Jung Soo |e verfasserin |4 aut | |
| 700 | 1 | |a Salman, Zara |e verfasserin |4 aut | |
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| 700 | 1 | |a Williams, Tracy Ann |e verfasserin |4 aut | |
| 700 | 1 | |a Cohen, Debbie L |e verfasserin |4 aut | |
| 700 | 1 | |a Wachtel, Heather |e verfasserin |4 aut | |
| 700 | 1 | |a Zhang, Jinghong |e verfasserin |4 aut | |
| 700 | 1 | |a Dorwal, Pranav |e verfasserin |4 aut | |
| 700 | 1 | |a Satoh, Fumitoshi |e verfasserin |4 aut | |
| 700 | 1 | |a Yang, Jun |e verfasserin |4 aut | |
| 700 | 1 | |a Lacroix, André |e verfasserin |4 aut | |
| 700 | 1 | |a Reincke, Martin |e verfasserin |4 aut | |
| 700 | 1 | |a Giordano, Tom J |e verfasserin |4 aut | |
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| 700 | 1 | |a Rainey, William E |e verfasserin |4 aut | |
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