New concepts in adrenal vein sampling for aldosterone in the diagnosis of primary aldosteronism

Rossi, Gian Paolo

doi:10.1007/s11906-007-0017-3

Cited by 40 publications

(28 citation statements)

References 55 publications

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“…14,15 The diagnosis of APA was based on the reported "4-corners" criteria, 1 which require a "biochemical" diagnosis of PA, a demonstration of adenoma, a lateralized aldosterone secretion and correction of PA, and a decrease of BP postadrenalectomy. 16 Once scheduled for adrenalectomy, the patients were put on a mineralocorticoid receptor antagonist to allow achieving of BP control for 2 main reasons: to undertake adrenalectomy with optimal control of BP and to avoid any treatment-related bias on vascular remodeling indexes.…”

Section: Diagnostic Tests and Criteriamentioning

confidence: 99%

“…Moreover, the possibility of accurately predicting the outcome of adrenalectomy is important not only for choosing the most appropriate therapeutic strategy but also for selecting the patients for AVS. The latter is necessary to identify the surgically curable forms of PA, 3,16 but because of costs and risks, 4,28 should be reserved for PA patients who are candidates for adrenalectomy and are likely to benefit from it. The fact that noninvasive techniques are being made available for assessing vascular remodeling 29 lends further support to the clinical relevance of the present results.…”

Section: Rossi Et Al Outcome Of Adrenalectomy In Primary Aldosteronismmentioning

confidence: 99%

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Vascular Remodeling and Duration of Hypertension Predict Outcome of Adrenalectomy in Primary Aldosteronism Patients

et al. 2008

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Abstract-Remodeling of the resistance arteries is a hallmark of arterial hypertension and predicts cardiovascular events, but it was unknown whether it could also predict the blood pressure response to adrenalectomy of patients with an aldosterone-producing adenoma. Therefore, we investigated the outcome of adrenalectomy as a function of vascular remodeling in the context of the preoperative features of aldosterone-producing adenoma patients. At 2 referral centers for hypertension, we prospectively measured the media:lumen ratio of small arteries from fat tissue of 50 consecutive aldosterone-producing adenoma patients treated with adrenalectomy. The blood pressure response to adrenalectomy was assessed by considering the blood pressure values and the number and dosages of antihypertensive medications. Adrenalectomy significantly (PϽ0.001) lowered plasma aldosterone (from 27.3Ϯ4.9 ng/dL to 8.3Ϯ11.2 ng/dL), the aldosterone:renin ratio (from 117Ϯ35 to 11Ϯ2), and blood pressure (from 163Ϯ22/98Ϯ2 mm Hg to 133Ϯ2/ 84Ϯ1 mm Hg), even despite a reduction (from 141Ϯ14 to 100Ϯ15; Pϭ0.02) of the score of antihypertensive treatment.It provided cure of hypertension in 30% of the aldosterone-producing adenoma patients, normotension with less antihypertensive therapy in 52%, and improved blood pressure control in the rest. The media:lumen ratio and the known duration of hypertension significantly predicted the blood pressure response to adrenalectomy at univariate and multivariate analyses. Because a long duration of hypertension and/or the presence of vascular remodeling imply lower chances of blood pressure normalization at long-term follow-up postadrenalectomy, these findings emphasize the importance of an early diagnosis of aldosterone-producing adenoma. Key Words: secondary hypertension Ⅲ aldosterone Ⅲ aldosteronism Ⅲ adrenalectomy Ⅲ outcome Ⅲ vascular remodeling P rimary aldosteronism (PA) is far more common than usually perceived and is attributable to an aldosteroneproducing adenoma (APA) in approximately half of the patients. 1 Thus, it entails the most common endocrine form of secondary arterial hypertension (HT) that is curable by adrenalectomy in many patients. 2 Identification of an APA, or unilateral primary adrenocortical hyperplasia, 3 requires adrenal vein sampling (AVS) that, being minimally risky, should be reserved for patients who are candidates for adrenalectomy and, more importantly, can benefit from it. 4 However, the identification of patients who will benefit more remains a challenging task, because the blood pressure (BP) response to adrenalectomy varies widely across patients. In fact, despite many efforts over the years, only age and lack of family history of HT were suggested to significantly predict the BP response. 5-8 Nevertheless, the large uncertainties in the prediction estimates render them of little, if any, 8 value on an individual basis.The remodeling of resistance arteries is a hallmark of arterial HT and can be implicated in the excess cardiovascular damage associated with HT. Hence, it ...

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Section: Diagnostic Tests and Criteriamentioning

confidence: 99%

Section: Rossi Et Al Outcome Of Adrenalectomy In Primary Aldosteronismmentioning

confidence: 99%

Vascular Remodeling and Duration of Hypertension Predict Outcome of Adrenalectomy in Primary Aldosteronism Patients

et al. 2008

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“…7,8 To this end, the current clinical practice guidelines advocate use of adrenal vein sampling (AVS) with measurement of plasma cortisol concentration (PCC) and plasma aldosterone concentration (PAC). 7,9 However, even though AVS may appear as a straightforward diagnostic test, [10][11][12] it is used only in few centers worldwide. Even some major referral centers do not use AVS routinely as shown by a recent large survey, the Adrenal Vein Sampling International Study (AVIS).…”

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confidence: 99%

“…Even some major referral centers do not use AVS routinely as shown by a recent large survey, the Adrenal Vein Sampling International Study (AVIS). 13 This underutilization is likely to be attributable to the misconception, largely based on anecdotal experiences and retrospective observational studies, 12 that AVS is technically challenging, invasive, risky, and not always necessary, despite abundant evidence to the contrary. 13 Furthermore, the lack of accepted standards for the performance of AVS and of established criteria for interpretation of its results creates additional hesitancy for appropriate use in many patients with PA.…”

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An Expert Consensus Statement on Use of Adrenal Vein Sampling for the Subtyping of Primary Aldosteronism

et al. 2014

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Abstract-Adrenal venous sampling is recommended by current guidelines to identify surgically curable causes of hyperaldosteronism but remains markedly underused. Key factors contributing to the poor use of adrenal venous sampling include the prevailing perceptions that it is a technically challenging procedure, difficult to interpret, and can be complicated by adrenal vein rupture. In addition, the lack of uniformly accepted standards for the performance of adrenal venous sampling contributes to its limited use. Hence, an international panel of experts working at major referral centers was assembled to provide updated advice on how to perform and interpret adrenal venous sampling. To this end, they were asked to use the PICO (Patient or Problem, Intervention, Control or comparison, Outcome) strategy to gather relevant information from the literature and to rely on their own experience. The level of evidence/recommendation was provided according to American Heart Association gradings whenever possible. A consensus was reached on several key issues, including the selection and preparation of the patients for adrenal venous sampling, the procedure for its optimal performance, and the interpretation of its results for diagnostic purposes even in the most challenging

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“…Hence, it is unlikely that cosyntropin stimulation can provide a final solution to the issue of time-dependent stressrelated effects on AVS results (8). In spite of all these premises, a stress reaction during AVS has never been systematically investigated as yet (13,14,15). Likewise, whether it could differently affect assessment of selectivity when using the bilaterally simultaneous or the sequential catheterization technique remains unknown.…”

Section: Introductionmentioning

confidence: 99%

A stress reaction affects assessment of selectivity of adrenal venous sampling and of lateralization of aldosterone excess in primary aldosteronism

Seccia

Miotto²,

Battistel³

et al. 2012

European Journal of Endocrinology

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Background: A stress reaction involving increased cortisol release, which has not been documented thus far, might affect the assessment of selectivity of catheterization during adrenal venous sampling (AVS). Objective: To investigate whether an ACTH-driven cortisol release occurs during AVS and whether it influences the assessment of selectivity by the step-up of cortisol (plasma cortisol concentrations, PCC) between the adrenal vein blood (PCC SIDE ) and the inferior vena cava (PCC IVC ), e.g. the selectivity index (SI). Design and methods: We determined the SI in samples obtained simultaneously at starting AVS (t-15) and again after 15 min (t0) in 34 consecutive patients with proven aldosterone-producing adenoma. We then calculated the SI with PCC SIDE obtained at t-15 and at t0, and the PCC IVC values obtained at the different time point, thus simulating sequential AVS. Results: The PCC SIDE and the SI fell significantly from t-15 to t0 on both the sides. When PCC SIDE obtained at t-15 was combined with PCC IVC at t0, the SI values were higher than those obtained with simultaneously drawn samples. This led to label as selective more AVS studies than with bilaterally simultaneous data, especially when using higher cutoffs for the SI. Conclusions: A transient increase in cortisol release from both adrenal glands occurs in the majority of the patients who undergo AVS. This stress reaction can influence the assessment of both the selectivity of the catheterization during the sequential AVS technique and the lateralization of aldosterone excess.

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New concepts in adrenal vein sampling for aldosterone in the diagnosis of primary aldosteronism

Cited by 40 publications

References 55 publications

Vascular Remodeling and Duration of Hypertension Predict Outcome of Adrenalectomy in Primary Aldosteronism Patients

Vascular Remodeling and Duration of Hypertension Predict Outcome of Adrenalectomy in Primary Aldosteronism Patients

An Expert Consensus Statement on Use of Adrenal Vein Sampling for the Subtyping of Primary Aldosteronism

A stress reaction affects assessment of selectivity of adrenal venous sampling and of lateralization of aldosterone excess in primary aldosteronism

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