Optimization of left adrenal vein sampling in primary aldosteronism: Coping with asymmetrical cortisol secretion

Kishino, Mitsuhiro; Yoshimoto, Takanobu; Nakadate, Masashi; Katada, Yoshiaki; Kanda, Eiichiro; Nakaminato, Shuichiro; Saida, Yukihisa; Ogawa, Yoshihiro; Tateishi, Ukihide

doi:10.1507/endocrj.ej16-0433

Cited by 16 publications

(10 citation statements)

References 20 publications

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“…AVS was performed with each adrenal vein cannulated sequentially (left before right) and without adrenocorticotropic hormone (ACTH) stimulation. Since unilateral cortisol overproduction and contralateral suppression coupled with a higher peripheral cortisol level would limit its usefulness for assessing cannulation success in patients with concomitant APA and SCH ( selectivity index ) [23, 24], successful cannulation of the adrenal veins was assessed by an adrenal/peripheral venous aldosterone gradient Similarly, since lateralization ratio ( lateralization index ) would not be accurate, the absolute value of plasma aldosterone levels was employed for diagnostic criteria of laterality for aldosterone hypersecretion [8]. The presence of the syndrome of glucocorticoid-remediable aldosteronism was excluded by the long polymerase chain reaction test [25].…”

Section: Methodsmentioning

confidence: 99%

Histopathological and genetic characterization of aldosterone-producing adenomas with concurrent subclinical cortisol hypersecretion: a case series

et al. 2017

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Purpose Aldosterone-producing adenomas with concurrent subclinical cortisol hypersecretion are reported in an increasing number of patients. Five aldosterone-producing adenomas from patients with primary aldosteronism and subclinical hypercortisolism were examined. The aims of our study were: (1) to analyze pathological features and immunohistochemical expression of CYP11B1 (11β-hydroxylase) and CYP11B2 (aldosterone synthase) in these tumors; (2) to investigate somatic mutations involved in adrenal steroid hypersecretion and/or tumor growth. Methods Archival micro-dissected paraffin-embedded slides from tumor specimens were used for histological and molecular studies. Immunohistochemistry was performed using monoclonal anti-CYP11B1 and anti-CYP11B2 antibodies. Cellular composition was determined by examining for known features of zona fasciculata and zona glomerulosa, and immunoreactivity for CYP11B1 and CYP11B2 by McCarty H-score. Spot regions for mutations in KCNJ5, ATP1A1, ATP2B3, CACNA1D, PRKACA, and CTNNB1 gene sequences were evaluated. Results Four APAs showed a predominant (≥50%) zona fasciculata-like cell pattern: one tumor had CYP11B1 H-score = 150, no detectable CYP11B2 expression, and harbored a PRKACA p.Leu206Arg mutation (that we have reported previously elsewhere), one had no CYP11B1 expression, CYP11B2 H-score = 40, and no mutations; the remaining two adenomas had high CYP11B1 H-score (160 and 240, respectively) and low CYP11B2 H-score (30 and 15, respectively), with the latter harboring a CTNNB1 p. Ser45Phe activating mutation. One of five aldosterone-producing adenomas had a predominant zona glomerulosa-like pattern, CYP11B1 H-score = 15, CYP11B2 H-score = 180, and no mutations. Conclusions The majority of aldosterone-producing adenomas with concurrent subclinical cortisol hypersecretion were composed mainly of zona fasciculata-like cells, while CYP11B1 and CYP11B2 immunostaining demonstrated clear heterogeneity. In a subset of cases, different somatic mutations may be involved in hormone excess and tumor formation.

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Section: Methodsmentioning

confidence: 99%

Histopathological and genetic characterization of aldosterone-producing adenomas with concurrent subclinical cortisol hypersecretion: a case series

et al. 2017

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“…Recently, several studies used suppression of serum aldosterone levels in uninvolved contralateral adrenal as an optional criterion to confirm APA [ 6 – 8 ]. However, these data were investigated only in patients who underwent adrenalectomy immediately after AVS.…”

Section: Introductionmentioning

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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“…Избыточная продукция кортизола в надпочечниках может сделать недостоверными результаты ССВЗК при расчете КЛ по уровню кортизола (ложное снижение отношения А/К на стороне гиперпродукции кортизола, ложное повышение на контралатеральной стороне) [44]. В таких случаях для интерпретации результатов ССВЗК и определения латерализации некоторыми специалистами предлагается сравнительная оценка плазменной концентрации альдостерона как таковой без коррекции по уровню кортизола [45]. При этом для максимального достижения нивелирования разведения концентрации альдостерона вненадпочечниковой кровью забор рекомендовано проводить непосредственно из надпочечниковых вен [45].…”

Section: îáñóAeäåíèåunclassified

“…В таких случаях для интерпретации результатов ССВЗК и определения латерализации некоторыми специалистами предлагается сравнительная оценка плазменной концентрации альдостерона как таковой без коррекции по уровню кортизола [45]. При этом для максимального достижения нивелирования разведения концентрации альдостерона вненадпочечниковой кровью забор рекомендовано проводить непосредственно из надпочечниковых вен [45]. В качестве альтернативного метода также предложено определение КС и КЛ по уровню метанефрина [46].…”

Section: îáñóAeäåíèåunclassified

“…С учетом небольших размеров образования правого надпочечника, сохранного ритма секреции АКТГ и кортизола при значениях в пределах референсных интервалов, наличие кортикостеромы сочтено маловероятным. Тем не менее, гипотетически предположив, что у пациентки Б. имелась относительная гиперсекреция кортизола, и использовав для расчета показатели альдостерона без коррекции по уровню кортизола, мы получили тот же результат, так как забор крови проводился непосредственно из надпочечниковых вен, а концентрация альдостерона слева значимо превышала таковую справа и значение 14 000 пг/мл (38 840 пмоль/л), что является чувствительным критерием, подтверждающим латерализацию в подобных случаях [45]. Методика определения селективности катетеризации на основании уровня метанефрина плазмы в нашем центре пока на стадии внедрения.…”

Section: îáñóAeäåíèåunclassified

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Primary hyperaldosteronism: difficulties in diagnosis

Shifman

Михайлович²,

Платонова

et al. 2019

Terapevticheskii arkhiv

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Primary hyperaldosteronism (PA) - is the clinical syndrome, results from autonomous of the major regulators of secretion, aldosterone overproduction by a tumorous or hyperplastic tissue in adrenal cortex. Being the most frequent cause of secondary hypertension, PA may be represented by disorders with unilateral or bilateral aldosterone overproduction and differential diagnosis between them is crucial for choosing a right therapeutic approache: lifelong medical therapy with mineralocorticoid receptor antagonists or unilateral adrenalectomy. Adrenal venous sampling (AVS) is currently the «gold standard» test for identifying laterality of excess hormone production, unlike imaging tests, sensitivity and specificity of which is not enough, due to inability to evaluate functional activity with confidence, and also to limitations in detecting tiny abnormalities of adrenals, such as microadenoma or hyperplasia. Excluding certain cases, AVS is recommended to patients with confirmed PA, planning surgical treatment, to determine the lateralization of aldosterone hypersecretion. Described clinical case of patient with confirmed lateralization from adrenal without any detected lesions on CT-imaging and nonfunctioning tumour on contralateral side, highlights the importance of using AVS for decision to refer patients for surgery.

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Optimization of left adrenal vein sampling in primary aldosteronism: Coping with asymmetrical cortisol secretion

Cited by 16 publications

References 20 publications

Histopathological and genetic characterization of aldosterone-producing adenomas with concurrent subclinical cortisol hypersecretion: a case series

Histopathological and genetic characterization of aldosterone-producing adenomas with concurrent subclinical cortisol hypersecretion: a case series

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

Primary hyperaldosteronism: difficulties in diagnosis

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