Surgical treatment outcome of primary aldosteronism assessed using new modified diagnostic tests

Alexandraki, Krystallenia Ι.; Markou, Αthina; Papanastasiou, Labrini; Tyfoxylou, Ernestini; Kapsali, Chara; Gravvanis, Christos; Katsiveli, Pinelopi; Kaltsas, Gregory; Zografos, George; Chrousos, George P.; Piaditis, George

doi:10.1007/s42000-021-00280-8

Cited by 3 publications

(4 citation statements)

References 27 publications

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“…Any pharmacological treatment protocol should be designed taking into consideration issues such as drug-related complications and compliance. We found that our 5-day oral prednisone treatment, taken as a single dose in the morning after breakfast, was well tolerated and devoid of serious side effects; this 5-day regimen is unlikely to result in metabolic decompensation or hypothalamic–pituitary–adrenal axis suppression (20). Similarly, patients tolerated the 2-week course of NAC well.…”

Section: Discussionmentioning

confidence: 99%

Functional Hearing Preservation in Cochlear Implantation: The Miami Cocktail Effect

Angeli,

Brown,

Holcomb

et al. 2024

Otol Neurotol

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Objective To investigate if pharmacological treatment with prednisone and L-N-acetylcysteine (STE + NAC) influence functional hearing preservation in cochlear implant (CI) surgery. Study Designs Preimplantation and postimplantation longitudinal case–control study. Setting Tertiary referral center. Patients Pediatric and adult recipients of CI with preimplantation functional hearing defined as an average of air-conducted thresholds at 125, 250, and 500 Hz (low-frequency pure-tone average [LFPTA]) <80 dB. Interventions Preimplantation and postimplantation audiometry. Weight-adjusted oral prednisone and L-N-acetylcysteine starting 2 days before surgery (Miami cocktail). Prednisone was continued for 3 days and L-N-acetylcysteine for 12 days after surgery, respectively. Cochlear implantation with conventional length electrodes. Main Outcome Measures Proportion of patients with LFPTA <80 dB, and LFPTA change at 1-year postimplantation. Results All 61 patients received intratympanic and intravenous dexamethasone intraoperatively, with 41 patients receiving STE + NAC and 20 patients not receiving STE + NAC. At 1-year postimplantation, the proportion of functional hearing preservation was 83% in the STE + NAC group compared with 55% of subjects who did not receive STE + NAC (p = 0.0302). The median LFPTA change for STE + NAC-treated and not treated subjects was 8.33 dB (mean, 13.82 ± 17.4 dB) and 18.34 dB (mean, 26.5 ± 23.4 dB), respectively (p = 0.0401, Wilcoxon rank test). Perioperative STE + NAC treatment resulted in 10 dB of LFPTA better hearing than when not receiving this treatment. Better low-frequency preimplantation hearing thresholds were predictive of postimplantation functional hearing. No serious side effects were reported. Conclusion Perioperative STE + NAC, “The Miami Cocktail,” was safe and superior to intraoperative steroids alone in functional hearing preservation 1-year after cochlear implantation.

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Section: Discussionmentioning

confidence: 99%

Functional Hearing Preservation in Cochlear Implantation: The Miami Cocktail Effect

Angeli,

Brown,

Holcomb

et al. 2024

Otol Neurotol

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“…The suppression of the HPA axis can persist for up to 12 months after the cessation of exogenous glucocorticoid use. 8 …”

Section: Discussionmentioning

confidence: 99%

“…The cosyntropin stimulation test is used to differentiate between various forms of AI. 8 Cosyntropin is a derivative of ACTH used to differentiate between primary and secondary AI. 9 The patient's cortisol levels were responsive to a prolonged stimulation of ACTH by cosyntropin, which rules in secondary AI.…”

Section: Discussionmentioning

confidence: 99%

A case of iatrogenic Cushing syndrome and subsequent adrenal insufficiency from a hidden ingredient in the supplement Artri Ajo King

2023

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Dietary supplement use is common in the United States. Supplements are regulated by the US Food and Drug Administration (FDA) under a separate set of guidelines from typical food and drug products. This case report describes a patient who presented to the emergency department (ED) with abdominal pain, vomiting, and generalized weakness. On detailed history, we learned that he had been taking a supplement called Artri Ajo King for 18 months, followed by recent abrupt cessation before his ED presentation. He was subsequently found to have a low serum cortisol level and was diagnosed with secondary adrenal insufficiency by a cosyntropin stimulation test. Ultimately, he was started on hydrocortisone with resolution of his symptoms. This case illustrates the consequence of allowing dietary supplements to be sold before FDA evaluation as well as the importance of physicians eliciting history of supplement use and offering a culturally competent discussion with their patients regarding supplement use.

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“…The FST is based on the suppression of renin, angiotensin-II, and aldosterone production secondary to extrinsic mineralocorticoid excess. One additional test, the dexamethasone suppression test (DST) [77], is used when glucocorticoid-remediable aldosteronism is suspected: young onset HT induced by PA. Other tests, in addition to suppression of renin-angiotensin-II, seek the blockade of physiological ACTH stimulus of aldosterone production to diminish the rate of false positives [78,79]. A recently described test combining a double blockade of angiotensin-II stimulus (using captopril and valsartan) with the blockade of ACTH stimulus of aldosterone production (using dexamethasone) could be of use in some clinical situations [78].…”

Section: Confirmatory Testsmentioning

confidence: 99%

Primary Hyperaldosteronism: When to Suspect It and How to Confirm Its Diagnosis

et al. 2022

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The definition of primary hyperaldosteronism (PA) has shifted, as progress has been made in understanding the disease. PA can be produced by unilateral or bilateral cortical adrenal hyperproduction of aldosterone, due to hyperplasia, aldosterone-secreting cell clusters, aldosterone-producing macro or micro adenoma/s, and combinations of the above, or by an aldosterone-producing carcinoma. PA is a highly prevalent disease, affecting close to 10% of the hypertensive population. However, PA is clearly underdiagnosed. The purpose of this review is to address current knowledge of PA’s clinical manifestations, as well as current methods of diagnosis. PA is associated with a higher cardiovascular morbidity and mortality than essential hypertension with similar blood pressure control. Young hypertensive patients, those with a first-degree relative with PA or ictus, and/or those with apnea/hypopnea syndrome, moderate/severe/resistant hypertension, adrenal incidentaloma, and/or hypokalemia should be screened for PA. PA can induce atrial fibrillation (AF), and those patients should also be screened for PA. We propose the use of the Captopril challenge test (CCT), oral salt loading, or intravenous salt loading for PA diagnosis, given their availability in the majority of hospital centers. CCT could be first-line, since it is safe and easy to perform.

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Surgical treatment outcome of primary aldosteronism assessed using new modified diagnostic tests

Cited by 3 publications

References 27 publications

Functional Hearing Preservation in Cochlear Implantation: The Miami Cocktail Effect

Functional Hearing Preservation in Cochlear Implantation: The Miami Cocktail Effect

A case of iatrogenic Cushing syndrome and subsequent adrenal insufficiency from a hidden ingredient in the supplement Artri Ajo King

Primary Hyperaldosteronism: When to Suspect It and How to Confirm Its Diagnosis

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