Contralateral suppression of aldosterone at adrenal venous sampling predicts hyperkalemia following adrenalectomy for primary aldosteronism

Shariq, Omair A.; Bancos, Irina; Cronin, Patricia A.; Farley, David R.; Richards, Melanie L.; Thompson, Geoffrey B.; Young, William F.; McKenzie, Travis J.

doi:10.1016/j.surg.2017.07.034

Cited by 32 publications

(32 citation statements)

References 23 publications

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“…Several studies investigated the utility of CSI for differentiating APA from BAH and for predicting the outcomes of patients with HTN and hypokalemia [6,7,[23][24][25][26]. LI with cosyntropin infusion greater than 4 is definitively diagnostic of APA and LI less than 2 [27] is diagnostic of BAH.…”

Section: Discussionmentioning

confidence: 99%

Clinical outcomes of primary aldosteronism based on lateralization index and contralateral suppression index after adrenal venous sampling in real-world practice: a retrospective cohort study

Lee

Kang

et al. 2020

BMC Endocr Disord

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Background: We investigated whether the contralateral suppression index in aldosterone-producing adrenal adenoma could be used as a diagnostic criterion when catheterization in either right or left adrenal vein fails or when a discrepancy in the adrenal vein sampling (AVS) results and imaging findings occurs in the real-world practice. Methods: We retrospectively reviewed 48 patients who had resistant hypertension (HTN) or hypokalemia with a biochemical diagnosis of primary aldosteronism and who underwent AVS from January 2009 to June 2017 at a tertiary referral hospital. Selection index (SI), lateralization index (LI), and contralateral suppression index (CSI) were calculated based on AVS results and the final clinical outcomes were evaluated. Results: The catheterization of both adrenal veins was successful in 43 of 48 (89.6%) patients. The lateralization based only on LI was performed in 23 out of 43 (53.5%) patients. When CSI and LI were combined in decision making, the concordance between adrenal computed tomography scan and AVS for unilateral lesion improved from 59.3% (19/32) to 75.0% (24/32). CSI also correlated well with unilateral adrenal disease in the catheterization failure group. The final outcomes of HTN were better in the contralateral suppression group. Conclusion: CSI combined with LI could be a supplementary diagnostic tool in patients with non-lateralization or catheterization failure and predict the clinical outcomes of HTN in patients with primary aldosteronism.

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Section: Discussionmentioning

confidence: 99%

Clinical outcomes of primary aldosteronism based on lateralization index and contralateral suppression index after adrenal venous sampling in real-world practice: a retrospective cohort study

Lee

Kang

et al. 2020

BMC Endocr Disord

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“…In a multicentre study of 142 surgically treated patients, the prevalence of postoperative hyperkalemic was 9.9%; the hyperkalemic patients were older and had worse renal function than the nonhyperkalemic patient group . In a study of 192 patients with PA who were treated surgically, 12 (6.3%) developed postoperative hyperkalemia (median serum potassium 5.5 mmol L −1 , range 5.2–6.2 mmol L −1 ); median time to onset was 13.5 days (range 7–55 days) . Five patients had transiently increased serum potassium concentrations that normalized spontaneously.…”

Section: Principles Of Treatmentmentioning

confidence: 99%

“…In addition, if AVS is not bilaterally successful, a CSI of <0.5 is highly predictive of contralateral disease . Also, patients with a CSI of <0.47 are at increased risk for postoperative hyperkalemia (see treatment section below) .…”

Section: Diagnosismentioning

confidence: 99%

Diagnosis and treatment of primary aldosteronism: practical clinical perspectives

2018

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Primary aldosteronism (PA), the most common form of secondary hypertension, can be either surgically cured or treated with targeted pharmacotherapy. PA is frequently undiagnosed and untreated, leading to aldosterone‐specific cardiovascular morbidity and nephrotoxicity. Thus, clinicians should perform case detection testing for PA at least once in all patients with hypertension. Confirmatory testing is indicated in most patients with positive case detection testing results. The next step is to determine whether patients with confirmed PA have a disease that can be cured with surgery or whether it should be treated medically; this step is guided by computed tomography scan of the adrenal glands and adrenal venous sampling. With appropriate surgical expertise, laparoscopic unilateral adrenalectomy is safe, efficient and curative in patients with unilateral adrenal disease. In patients who have bilateral aldosterone hypersecretion, the optimal management is a low‐sodium diet and lifelong treatment with a mineralocorticoid receptor antagonist administered at a dosage to maintain a high–normal serum potassium concentration without the aid of oral potassium supplements.

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“…Compared with MRA, surgical treatment reduces PTH levels more obviously in PA patients (77). However, adrenalectomy can cause short-term aldosterone deficiency, resulting in hyperkalemia (92), and can even cause adrenal insufficiency, such as Addison's disease, which is rare (93). The findings mentioned above provide convincing evidence for a causal relationship between the RAAS and PTH levels.…”

Section: Changes In Pth After the Inhibition Of Raas Functionmentioning

confidence: 99%

The Interplay Between the Renin-Angiotensin-Aldosterone System and Parathyroid Hormone

Zheng

et al. 2020

Front. Endocrinol.

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The renin-angiotensin-aldosterone system (RAAS) is the regulatory system by which renin induces aldosterone production. Angiotensin II (Ang II) is the main effector substance of the RAAS. The RAAS regulates blood pressure and electrolyte balance by controlling blood volume and peripheral resistance. Excessive activation of the RAAS is an important factor in the onset of cardiovascular disease and the deterioration of this disease. The most common RAAS abnormality is primary aldosteronism (PA). Parathyroid hormone (PTH) is a peptide secreted by the main cells of the parathyroid gland, which promotes elevated blood calcium (Ca 2+) levels and decreased blood phosphorus (Pi) levels. Excessive secretion of PTH can cause primary hyperparathyroidism (PHPT). Parathyroidism is highly prevalent in postmenopausal women and is often associated with secondary osteoporosis. PA and PHPT are common endocrine system diseases. However, studies have shown a link between the RAAS and PTH, indicating a positive relationship between them. In this review, we explore the complex bidirectional relationship between the RAAS and PTH. We also point out possible future treatment options for related diseases based on this relationship.

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Contralateral suppression of aldosterone at adrenal venous sampling predicts hyperkalemia following adrenalectomy for primary aldosteronism

Cited by 32 publications

References 23 publications

Clinical outcomes of primary aldosteronism based on lateralization index and contralateral suppression index after adrenal venous sampling in real-world practice: a retrospective cohort study

Clinical outcomes of primary aldosteronism based on lateralization index and contralateral suppression index after adrenal venous sampling in real-world practice: a retrospective cohort study

Diagnosis and treatment of primary aldosteronism: practical clinical perspectives

The Interplay Between the Renin-Angiotensin-Aldosterone System and Parathyroid Hormone

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