Adrenal venous sampling in primary aldosteronism: Experience of a Spanish multicentric study (Results from the SPAIN-ALDO Register)

Araujo‐Castro, Marta; Fano, Miguel Paja; Boillos, Marga González; Peris, Begoña Pla; Pascual‐Corrales, Eider; Cano, A.; Ramírez, Paola Parra; Rojas-Marcos, Patricia Martín; Ruiz-Sánchez, Jorge Gabriel; Delgado, Almudena Vicente; Hoyos, Emilia Gómez; Ferreira, Rui; Sanz, Íñigo García; Sala, Monica; Millán, Rebeca Barahona San; César, María José Picón; Guardiola, Patricia Díaz; González, Juan Jesús García; Perdomo, Carolina M; Miguélez, Laura Manjón; Centeno, Rogelio García; Percovich, Juan Carlos; Román, Ángel Rebollo; Gimeno, Paola Gracia; Lázaro, Cristina Robles; Morales-Ruíz, Manuel; Hanzu, Felicia A.

doi:10.1007/s12020-022-03122-8

Cited by 17 publications

(7 citation statements)

References 45 publications

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“…The current Endocrine Society guideline recommends performing AVS in all patients with PA so as to identify those who may benefit from surgery 2 . However, some recent research results have cast uncertainty on the role of AVS 15,21,22 . The SPARTACUS study found no difference in clinical outcomes between CT‐ and AVS‐based management 15 .…”

Section: Discussionmentioning

confidence: 99%

“…The SPARTACUS study found no difference in clinical outcomes between CT‐ and AVS‐based management 15 . Other studies also did not report significant differences in biochemical response and clinical resolution between patients who underwent surgery based on CT and AVS results 21,22 . Additionally, not all patients with unilateral adrenal aldosterone hypersecretion diagnosed by AVS can achieve complete biochemical remission after adrenalectomy 16,23 .…”

Section: Discussionmentioning

confidence: 99%

“…In the AVS study, only 77% of patients at 20 referral centers were systematically sent for AVS 25 . Additionally, the successful cannulation rates of both adrenal veins are widely variable in different studies, ranging from 20% to 99% 22,25,26 . CT might be reliable for PA patients with visible unilateral adenoma when AVS cannot be obtained for technical reasons.…”

Section: Discussionmentioning

confidence: 99%

“…2 However, some recent research results have cast uncertainty on the role of AVS. 15,21,22 The SPARTACUS study found no difference in clinical outcomes between CT-and AVS-based management. 15 Other studies also did not report significant differences in biochemical response and clinical resolution between patients who underwent surgery based on CT and AVS results.…”

Section: Discussionmentioning

confidence: 99%

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Surgery based on computed tomography images might be feasible for primary aldosteronism patients with visible unilateral adenoma

Fang,

Dai,

Zhao

et al. 2023

J of Clinical Hypertension

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Primary aldosteronism (PA) with unilateral adrenal disease can be cured or improved by adrenalectomy. Adrenal venous sampling (AVS) is recommended to identify patients for surgical management. However, surgeries based on computed tomography (CT) images are only advocated for PA patients aged <35 with visible unilateral adenoma. Herein, we aimed to compare CT‐based and AVS‐based surgery outcomes for PA patients with visible unilateral adenomas for different age groups. A total of 178 PA patients who underwent unilateral adrenalectomy between June 2018 and January 2021 were included in the study based on CT (n = 54) or AVS (n = 124). Demographics, diagnostics, and follow‐up data were retrospectively collected. Clinical and biochemical outcomes were analyzed according to Primary Aldosteronism Surgical Outcome (PASO) criteria at 1‐year follow‐up. Our results showed that complete clinical success (46.3% vs. 47.6%, p = 0.875) and complete biochemical success (88.8% vs. 91.9%, p = 0.515) were similar between the two groups. Age stratification revealed that patients >55 years old were likely to have worse biochemical outcomes; however, these were still not significantly different (21.4% vs. 8.6%, p = 0.220). Of the 114 AVS‐based patients who achieved complete biochemical success, 37 (32.4%) with bilateral normal or bilateral abnormal CT images changed treatment options according to AVS results, 1 (0.9%) avoided adrenalectomy on the wrong side. Our results indicated that surgery based on CT images might be feasible for highly selected PA patients with visible unilateral adenomas and less limited by age, while for those with normal adrenal or bilateral adrenal lesions, treatment strategy must be decided by AVS.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Surgery based on computed tomography images might be feasible for primary aldosteronism patients with visible unilateral adenoma

Fang,

Dai,

Zhao

et al. 2023

J of Clinical Hypertension

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“…There are more reasons why we question the current guidelines. First, complications in connection with AVS are rare and most often mild [15][16][17]. For instance, in a large international study with information from 2604 AVS conducted at 20 centers, the overall rate of adrenal vein rupture, a dreaded and serious complication, was only 0.6 % [17].…”

mentioning

confidence: 99%

Adrenal Vein Sampling in the Young – Necessary or Not?

Gkaniatsa¹,

Ragnarsson

2023

Exp Clin Endocrinol Diabetes

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Current clinical guidelines from the US Endocrine Society state that AVS may not be necessary in patients younger than 35 years who have marked aldosteronism and a solitary adrenal adenoma on imaging. At the time when the guidelines were published, only one study supported the statement, a study that included 6 patients younger than 35 years, all of whom who had unilateral adenoma on imaging and unilateral primary aldosteronism (PA) according to adrenal venous sampling (AVS). Since then, to our knowledge, four additional studies have been published that provide data on concordance between conventional imaging and AVS among patients younger than 35 years. In these studies, 7 of 66 patients with unilateral disease on imaging had bilateral disease according to AVS. We find it therefore reasonable to conclude that imaging studies alone inaccurately predict laterality in a significant number of young patients with PA, and that available data challenge the current clinical guidelines.

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Epidemiology and diagnosis of primary aldosteronism. What have we learned from the SPAIN-ALDO registry?

Araujo-Castro,

Pascual-Corrales,

Martín Rojas

et al. 2023

Endocrine

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Adrenal venous sampling in primary aldosteronism: Experience of a Spanish multicentric study (Results from the SPAIN-ALDO Register)

Cited by 17 publications

References 45 publications

Surgery based on computed tomography images might be feasible for primary aldosteronism patients with visible unilateral adenoma

Surgery based on computed tomography images might be feasible for primary aldosteronism patients with visible unilateral adenoma

Adrenal Vein Sampling in the Young – Necessary or Not?

Epidemiology and diagnosis of primary aldosteronism. What have we learned from the SPAIN-ALDO registry?

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