Effect of cosyntropin during adrenal venous sampling on subtype of primary aldosteronism: analysis of surgical outcome

in European Journal of Endocrinology

Correspondence should be addressed to H Kobayashi or M Abe; Email: kobayashi.hiroki@nihon-u.ac.jp or abe.masanori@nihon-u.ac.jp
Restricted access

Objectives

We investigated the clinical significance of ACTH stimulation during adrenal venous sampling (AVS) by surgical outcome of primary aldosteronism (PA).

Design

Multicenter retrospective study by Japan PA study.

Method

We allocated 314 patients with both basal and ACTH-stimulated AVS data who underwent adrenalectomy to three groups: basal lateralization index (LI) ≥2 with ACTH-stimulated LI ≥4 on the ipsilateral side (Unilateral (U) to U group, n = 245); basal LI <2 with ACTH-stimulated LI ≥4 (Bilateral (B) to U group, n = 15); and basal LI ≥2 with ACTH-stimulated LI <4 (U to B group, n = 54). We compared surgical outcomes among the groups using the Primary Aldosteronism Surgical Outcome (PASO) criteria.

Results

Compared with U to U group, U to B group had poor clinical and biochemical outcomes and low rates of adrenal adenoma as pathological findings (P = 0.044, 0.006, and 0.048, respectively), although there were no significant differences between U to U and B to U groups. All patients in U to B group with clinical and biochemical benefits, however, had adrenal adenoma as pathological findings and could be well differentiated from those with poor surgical outcomes via basal LI (>8.3), but not ACTH-stimulated LI. These results were similar even when we defined each group based on a cut-off value of 4 for basal LI.

Conclusions

Although PA patients in U to B group had worse surgical outcomes than did those in U to U group, basal LI could discriminate among patients with better surgical outcomes in U to B group.

Supplementary Materials

    • ONLINE SUPPLEMENT
    • Table S1. Baseline characteristics of patients in the U to B group who underwent adrenalectomy and who did not
    • Table S2. Baseline characteristics of patients in the U to B group with and without clinical benefit after adrenalectomy
    • Table S3. Baseline characteristics of patients in the U to B group with and without biochemical benefit after adrenalectomy
    • Table S4a. Baseline characteristics of patients in the U to B group with and without clinical benefit after adrenalectomy (according to the basal LI cut-off value of 4)
    • Table S5a. Baseline characteristics of patients in the U to B group with and without clinical benefit after adrenalectomy (only for patients whose ACTH stimulation were administered by bolus injection)
    • Table S6a. Adrenal venous sampling result for recurrent case of primary aldosteronism in U to B group who had better surgical outcome
    • Table S7a. Baseline characteristics of patients in the unilateral to bilateral group with and without clinical and biochemical benefits after adrenalectomy (according to the basal LI cut-off value of 4)
    • Table S8a. Baseline characteristics of patients in the unilateral to bilateral group with and without clinical and biochemical benefits after adrenalectomy (only for patients whose ACTH stimulation were administered by bolus injection)
    • Figure S1. Prevalence of each group defined by basal and ACTH stimulated laterality index on adrenal venous sampling in the study population Unilateral hyperaldosteronism on AVS was defined as a lateralization index &#x2265;4 at the baseline and &#x2265;4 after ACTH use.
    • Figure S2. Clinical outcomes (A), biochemical outcomes (B), and pathological findings (C) on adrenalectomy for each group defined as a lateralization index of &#x2265;4 at the baseline and &#x2265;4 after ACTH stimulation U to U: unilateral to unilateral, B to U: bilateral to unilateral, U to B: unilateral to bilateral, B to B: bilateral to bilateral
    • Figure S3. Clinical outcomes (A), biochemical outcomes (B), and pathological findings (C) on adrenalectomy for each group (Only for patients whose ACTH stimulation was administered by bolus injection) U to U: unilateral to unilateral, B to U: bilateral to unilateral, U to B: unilateral to bilateral, B to B: bilateral to bilateral

 

     European Society of Endocrinology

Sept 2018 onwards Past Year Past 30 Days
Abstract Views 371 371 371
Full Text Views 50 50 50
PDF Downloads 40 40 40