Basal contralateral aldosterone suppression is rare in lateralized primary aldosteronism

in European Journal of Endocrinology
View More View Less
  • 1 Division of Endocrinology, Department of Medicine
  • 2 Department of Radiology, Centre de Recherche du Centre hospitalier de l’Université de Montréal (CHUM), Université de Montréal, Québec, Canada
  • 3 Division of Endocrinology, Department of Medicine
  • 4 Department of Radiology, University of Calgary, Alberta, Canada

Correspondence should be addressed to A Lacroix; Email: andre.lacroix@umontreal.ca
Restricted access

Context:

Unilateral aldosteronomas should suppress renin and contralateral aldosterone secretion. Complete aldosterone suppression in contralateral adrenal vein sample (AVS) could predict surgical outcomes.

Objectives:

To retrospectively evaluate the prevalence of basal contralateral suppression using Aldosterone (A)contralateral(CL)/Aperipheral(P) as compared to (A/Cortisol(C)CL)/(A/C)P ratio in primary aldosteronism (PA) patients studied in two Canadian centers. To determine the best cut-off to predict clinical and biochemical surgical cure. To compare the accuracy of ACL/AP to the basal and post-ACTH lateralization index (LI) in predicting surgical cure.

Methods:

In total, 330 patients with PA and successful AVS were included; 124 lateralizing patients underwent surgery. Clinical and biochemical cure at 3 and 12 months were evaluated using the PASO criteria.

Results:

Using ACL/AP and (A/C)CL/(A/C)P at the cut-off of 1, the prevalence of contralateral suppression was 6 and 45%, respectively. Using ROC curves, the ACL/AP ratio is associated with clinical cure at 3 and 12 months and biochemical cure at 12 months. (A/C)CL/(A/C)P is associated with biochemical cure only. The cut-offs for ACL/AP offering the best sensitivity (Se) and specificity (Sp) for clinical and biochemical cures at 12 months are 2.15 (Se: 63% and Sp: 71%) and 6.15 (Se: 84% and Sp: 77%), respectively. Basal LI and post-ACTH LI are associated with clinical cure but only the post-ACTH LI is associated with biochemical cure.

Conclusions:

In lateralized PA, basal contralateral suppression defined by ACL/AP is rare and incomplete compared to the (A/C)CL/(A/C)P ratio and is associated with clinical and biochemical postoperative outcome, but with modest accuracy.

Supplementary Materials

    • Basal contralateral aldosterone suppression is rare in lateralized primary aldosteronism
    • Supplementary Table 1. Effect of degree of lateralization index on basal direct aldosterone contralateral suppression:
    • Supplementary Table 2. Detailed AVS data of the patients who underwent unilateral adrenalectomy and failed to achieve biochemical cure.
    • Supplementary figure 1

 

     European Society of Endocrinology

Sept 2018 onwards Past Year Past 30 Days
Abstract Views 708 708 311
Full Text Views 106 106 46
PDF Downloads 69 69 30
  • 1

    Monticone S, Burrello J, Tizzani D, Bertello C, Viola A, Buffolo F, Gabetti L, Mengozzi G, Williams TA & Rabbia F Prevalence and clinical manifestations of primary aldosteronism encountered in primary care practice. Journal of the American College of Cardiology 2017 69 18111820. (https://doi.org/10.1016/J.JACC.2017.01.052)

    • Search Google Scholar
    • Export Citation
  • 2

    Hannemann A, Wallaschofski H. Prevalence of primary aldosteronism in patient’s cohorts and in population-based studies – a review of the current literature. Hormone and Metabolic Research 2012 44 157162. (https://doi.org/10.1055/s-0031-1295438)

    • Search Google Scholar
    • Export Citation
  • 3

    Calhoun DA. Is there an unrecognized epidemic of primary aldosteronism? (Pro). Hypertension 2007 50 447453; discussion 447. (https://doi.org/10.1161/HYPERTENSIONAHA.106.086116)

    • Search Google Scholar
    • Export Citation
  • 4

    Monticone S, D’Ascenzo F, Moretti C, Williams TA, Veglio F, Gaita F, Mulatero P. Cardiovascular events and target organ damage in primary aldosteronism compared with essential hypertension: a systematic review and meta-analysis. Lancet: Diabetes and Endocrinology 2018 6 4150. (https://doi.org/10.1016/S2213-8587(17)30319-4)

    • Search Google Scholar
    • Export Citation
  • 5

    Funder JW, Carey RM, Mantero F, Murad MH, Reincke M, Shibata H, Stowasser M, Young WF. The management of primary aldosteronism: case detection, diagnosis, and treatment: an endocrine society clinical practice guideline. Journal of Clinical Endocrinology and Metabolism 2016 101 18891916. (https://doi.org/10.1210/jc.2015-4061)

    • Search Google Scholar
    • Export Citation
  • 6

    Rossi GP, Barisa M, Allolio B, Auchus RJ, Amar L, Cohen D, Degenhart C, Deinum J, Fisher E & Gordon R The adrenal vein sampling International study (avis) for identifying the major subtypes of primary aldosteronism. Journal of Clinical Endocrinology and Metabolism 2012 97 16061614. (https://doi.org/10.1210/jc.2011-2830)

    • Search Google Scholar
    • Export Citation
  • 7

    Rossitto G, Amar L, Azizi M, Riester A, Reincke M, Degenhart C, Widimsky J, Mitsuhide N, Deinum J & Schultzekool L Subtyping of primary aldosteronism in the AVIS-2 study: assessment of selectivity and lateralization. Journal of Clinical Endocrinology and Metabolism 2020 105 dgz017. (https://doi.org/10.1210/clinem/dgz017)

    • Search Google Scholar
    • Export Citation
  • 8

    Kline GA, Chin A, So B, Harvey A, Pasieka JL. Defining contralateral adrenal suppression in primary aldosteronism: implications for diagnosis and outcome. Clinical Endocrinology 2015 83 2027. (https://doi.org/10.1111/cen.12669)

    • Search Google Scholar
    • Export Citation
  • 9

    Wolley MJ, Gordon RD, Ahmed AH, Stowasser M. Does contralateral suppression at adrenal venous sampling predict outcome following unilateral adrenalectomy for primary aldosteronism? A retrospective study. Journal of Clinical Endocrinology and Metabolism 2015 100 14771484. (https://doi.org/10.1210/jc.2014-3676)

    • Search Google Scholar
    • Export Citation
  • 10

    Umakoshi H, Tanase-Nakao K, Wada N, Ichijo T, Sone M, Inagaki N, Katambi T, Kamemura K, Matsuda Y & Fujii Y Importance of contralateral aldosterone suppression during adrenal vein sampling in the subtype evaluation of primary aldosteronism. Clinical Endocrinology 2015 83 462467. (https://doi.org/10.1111/cen.12761)

    • Search Google Scholar
    • Export Citation
  • 11

    Monticone S, Satoh F, Viola A, Fischer E, Vonend O, Bernini G, Lucatello B, Quinkler M, Ronconi V & Morimoto R Aldosterone suppression on contralateral adrenal during adrenal vein sampling does not predict blood pressure response after adrenalectomy. Journal of Clinical Endocrinology and Metabolism 2014 99 41584166. (https://doi.org/10.1210/jc.2014-2345)

    • Search Google Scholar
    • Export Citation
  • 12

    Tagawa M, Ghosn M, Wachtel H, Fraker D, Townsend RR, Trerotola S, Cohen DL. Lateralization index but not contralateral suppression at adrenal vein sampling predicts improvement in blood pressure after adrenalectomy for primary aldosteronism. Journal of Human Hypertension 2017 31 444449. (https://doi.org/10.1038/jhh.2016.92)

    • Search Google Scholar
    • Export Citation
  • 13

    Fischer E, Degenhart C, Reincke M. Improving adrenal venous sampling in primary aldosteronism. Expert Review of Endocrinology and Metabolism 2012 7 531540. (https://doi.org/10.1586/eem.12.44)

    • Search Google Scholar
    • Export Citation
  • 14

    El Ghorayeb N, Mazzuco TL, Bourdeau I, Mailhot JP, Zhu PS, Thérasse E, Lacroix A. Basal and post-ACTH aldosterone and its ratios are useful during adrenal vein sampling in primary aldosteronism. Journal of Clinical Endocrinology and Metabolism 2016 101 18261835. (https://doi.org/10.1210/jc.2015-3915)

    • Search Google Scholar
    • Export Citation
  • 15

    Fischer E, Hanslik G, Pallauf A, Degenhart C, Linsenmaier U, Beuschlein F, Bidlingmaier M, Mussack T, Ladurner R & Hallfeldt K Prolonged zona glomerulosa insufficiency causing hyperkalemia in primary aldosteronism after adrenalectomy. Journal of Clinical Endocrinology and Metabolism 2012 97 39653973. (https://doi.org/10.1210/jc.2012-2234)

    • Search Google Scholar
    • Export Citation
  • 16

    Boulkroun S, Samson-Couterie B, Golib Dzib JF, Lefebvre H, Louiset E, Amar L, Plouin PF, Lalli E, Jeunemaitre X & Benecke A Adrenal cortex remodeling and functional zona glomerulosa hyperplasia in primary aldosteronism. Hypertension 2010 56 885892. (https://doi.org/10.1161/HYPERTENSIONAHA.110.158543)

    • Search Google Scholar
    • Export Citation
  • 17

    Fernandes-Rosa FL, Giscos-Duriez I, Amar L, Gomez-Sanchez CE, Meatchi T, Boulkroun S, Zennaro MC. Different somatic mutations in multinodular adrenals with aldosterone producing adenoma. Hypertension 2016 66 10141022. (https://doi.org/10.1161/HYPERTENSIONAHA.115.05993.Different)

    • Search Google Scholar
    • Export Citation
  • 18

    Williams TA, Lenders JWM, Mulatero P, Burrello J, Rottenkolber M, Adolf C, Satoh F, Amar L, Quinkler M & Deinum J Outcomes after adrenalectomy for unilateral primary aldosteronism: an international consensus on outcome measures and analysis of remission rates in an international cohort. Lancet. Diabetes and Endocrinology 2017 5 689699. (https://doi.org/10.1016/S2213-8587(17)30135-3)

    • Search Google Scholar
    • Export Citation
  • 19

    Hanley JA, McNeil BJ. The meaning and use of the area under a receiver operating characteristic (ROC) curve. Radiology 1982 143 2936. (https://doi.org/10.1148/radiology.143.1.7063747)

    • Search Google Scholar
    • Export Citation
  • 20

    DeLong ER, DeLong DM, Clarke-Pearson DL. Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach. Biometrics 1988 44 837845. (https://doi.org/10.2307/2531595)

    • Search Google Scholar
    • Export Citation
  • 21

    Zweig MH, Campbell G. Receiver-operating characteristic (ROC) plots: a fundamental evaluation tool in clinical medicine. Clinical Chemistry 1993 39 561577. (https://doi.org/10.1093/clinchem/39.4.561)

    • Search Google Scholar
    • Export Citation
  • 22

    Meyer LS, Wang X, Sušnik E, Burrello J, Burrello A, Castellano I, Eisenhofer G, Fallo F, Kline GA & Knösel T Immunohistopathology and steroid profiles associated with biochemical outcomes after adrenalectomy for unilateral primary aldosteronism. Hypertension 2018 72 650657. (https://doi.org/10.1161/HYPERTENSIONAHA.118.11465)

    • Search Google Scholar
    • Export Citation
  • 23

    Kline G, Leung A, So B, Chin A, Harvey A, Pasieka JL. Application of strict criteria in adrenal venous sampling increases the proportion of missed patients with unilateral disease who benefit from surgery for primary aldosteronism. Journal of Hypertension 2018 36 14071413. (https://doi.org/10.1097/HJH.0000000000001693)

    • Search Google Scholar
    • Export Citation
  • 24

    Rossi GP, Bolognesi M, Rizzoni D, Seccia TM, Piva A, Porteri E, Tiberio GAM, Giulini SM, Agabiti-Rosei E, Pessina AC. Vascular remodeling and duration of hypertension predict outcome of adrenalectomy in primary aldosteronism patients. Hypertension 2008 51 13661371. (https://doi.org/10.1161/HYPERTENSIONAHA.108.111369)

    • Search Google Scholar
    • Export Citation