The Adrenal Vein Sampling International Study (Avis) on Use and Interpretation of Adrenal Vein Sampling for Differentiating the Major Subtypes of Primary Aldosteronism

Rossi, Gian Paolo; Barisa, Marlena; Allolio, Bruno; Auchus, Richard J.; Kline, Gary; Lacroix, Audrey; Lenders, JW; Magill, Steven B.; Naruse, Masahiko; Nishikawa, T; Plouin, P. F.; Reincke, Martín; Rump, L. C.; Satoh, Fumitoshi; Stowasser, M.

doi:10.1097/00004872-201106001-00327

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“…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 . We, therefore, consider it less harmful to perform an AVS in young patients with PA rather than to perform potentially unnecessary unilateral adrenalectomy.…”

Section: Table 1 Summary Of Currently Available Studies...mentioning

confidence: 99%

“…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 .…”

Section: Table 1 Summary Of Currently Available Studies...mentioning

confidence: 99%

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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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Section: Table 1 Summary Of Currently Available Studies...mentioning

confidence: 99%

Section: Table 1 Summary Of Currently Available Studies...mentioning

confidence: 99%

Adrenal Vein Sampling in the Young – Necessary or Not?

Gkaniatsa¹,

Ragnarsson

2023

Exp Clin Endocrinol Diabetes

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A comprehensive review of the clinical aspects of primary aldosteronism

Rossi

2011

Nat Rev Endocrinol

100

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Primary aldosteronism is much more common than previously thought. The high prevalence of primary aldosteronism, the damage this condition does to the heart, blood vessels and kidneys (which causes a high rate of cardiovascular events), along with the notion that a timely diagnosis followed by an appropriate therapy can correct the arterial hypertension and hypokalemia, justify efforts to search for primary aldosteronism in many patients with hypertension. Most centers can use a cost-effective strategy to screen for patients with primary aldosteronism. By contrast, the identification of primary aldosteronism subtypes, which involves adrenal-vein sampling, should only be undertaken at tertiary referral centers that have experience in performing and interpreting this test. The identification of a curable form of primary aldosteronism can be beneficial for the patient. In some subgroups of patients with hypertension who are at high risk of primary aldosteronism or can benefit most from an accurate diagnosis, an aggressive diagnostic approach is necessary.

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The Adrenal Vein Sampling International Study (Avis) on Use and Interpretation of Adrenal Vein Sampling for Differentiating the Major Subtypes of Primary Aldosteronism

Cited by 2 publications

References 0 publications

Adrenal Vein Sampling in the Young – Necessary or Not?

Adrenal Vein Sampling in the Young – Necessary or Not?

A comprehensive review of the clinical aspects of primary aldosteronism

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