title: Aldosterone suppression on contralateral adrenal during adrenal vein sampling does not predict blood pressure response after adrenalectomy.
abstract: BACKGROUND
  Adrenal vein sampling (AVS) is the only reliable means to distinguish between aldosterone-producing adenoma and bilateral adrenal hyperplasia, the two most common subtypes of primary aldosteronism (PA). AVS protocols are not standardized and vary widely between centers.
  
  
  OBJECTIVE
  The objective of the study was to retrospectively investigate whether the presence of contralateral adrenal (CL) suppression of aldosterone secretion was associated with improved postoperative outcomes in patients who underwent unilateral adrenalectomy for PA.
  
  
  METHODS
  The study was carried out in eight different referral centers in Italy, Germany, and Japan.
  
  
  METHODS
  From 585 consecutive AVS in patients with confirmed PA, 234 procedures met the inclusion criteria and were used for the subsequent analyses.
  
  
  RESULTS
  Overall, 82% of patients displayed contralateral suppression. This percentage was significantly higher in ACTH stimulated compared with basal procedures (90% vs 77%). The CL ratio was inversely correlated with the aldosterone level at diagnosis and, among AVS parameters, with the lateralization index (P = .02 and P = .01, respectively). The absence of contralateral suppression was not associated with a lower rate of response to adrenalectomy in terms of both clinical and biochemical parameters, and patients with CL suppression underwent a significantly larger reduction in the aldosterone levels after adrenalectomy.
  
  
  CONCLUSIONS
  For patients with lateralizing indices of greater than 4 (which comprised the great majority of subjects in this study), CL suppression should not be required to refer patients to adrenalectomy because it is not associated with a larger blood pressure reduction after surgery and might exclude patients from curative surgery.
authors.affiliation: Division of Internal Medicine and Hypertension (S.M., A.V., J.B., F.V., P.M.), Department of Medical Sciences, and Division of Endocrinology, Diabetology, and Metabolism (B.L., M.M.), Department of Medical Sciences, and Department of Radiology (D.R.), University of Torino, 10126 Torino, Italy; Division of Nephrology, Endocrinology, and Vascular Medicine (F.S., R.M., M.K., Y.I., S.I.), Tohoku University Hospital, Sendai 980-8579, Japan; Medizinische Klinik und Poliklinik IV (E.F., A.R., M.R.), Campus Innenstadt, and Institut für Klinische Radiologie (C.D.), Ludwig Maximilians University Hospital, 81377 Munich, Germany; Departments of Nephrology (O.V., X.G.) and Endocrinology and Diabetology (H.S.D.), Medical Faculty, University of Düsseldorf, 40225 Düsseldorf, Germany; Department of Clinical and Experimental Medicine (G.B., D.C.), University of Pisa, 56126 Pisa, Italy; Department of Clinical Endocrinology (M.Q.), Charité Campus Mitte, Charité University Medicine Berlin and Endocrinology in Charlottenburg, 10627 Berlin, Germany; Division of Endocrinology (V.R., E.P., G.G.), Ospedali Riuniti Umberto I-GM Lancisi G Salesi, Università Politecnica delle Marche, 60126 Ancona, Italy; Clinical Chemistry Laboratory (G.M.), Azienda Ospedaliera Città della Salute e della Scienza di Torino, 10126 Torino, Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Monticone
authors.forename: Fumitoshi
authors.initials: F
authors.lastname: Satoh
authors.forename: Andrea
authors.initials: A
authors.lastname: Viola
authors.forename: Evelyn
authors.initials: E
authors.lastname: Fischer
authors.forename: Oliver
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authors.lastname: Vonend
authors.forename: Giampaolo
authors.initials: G
authors.lastname: Bernini
authors.forename: Barbara
authors.initials: B
authors.lastname: Lucatello
authors.forename: Marcus
authors.initials: M
authors.lastname: Quinkler
authors.forename: Vanessa
authors.initials: V
authors.lastname: Ronconi
authors.forename: Ryo
authors.initials: R
authors.lastname: Morimoto
authors.forename: Masataka
authors.initials: M
authors.lastname: Kudo
authors.forename: Christoph
authors.initials: C
authors.lastname: Degenhart
authors.forename: Xing
authors.initials: X
authors.lastname: Gao
authors.forename: Davide
authors.initials: D
authors.lastname: Carrara
authors.forename: Holger S
authors.initials: HS
authors.lastname: Willenberg
authors.forename: Denis
authors.initials: D
authors.lastname: Rossato
authors.forename: Giulio
authors.initials: G
authors.lastname: Mengozzi
authors.forename: Anna
authors.initials: A
authors.lastname: Riester
authors.forename: Enrico
authors.initials: E
authors.lastname: Paci
authors.forename: Yoshitsugu
authors.initials: Y
authors.lastname: Iwakura
authors.forename: Jacopo
authors.initials: J
authors.lastname: Burrello
authors.forename: Mauro
authors.initials: M
authors.lastname: Maccario
authors.forename: Gilberta
authors.initials: G
authors.lastname: Giacchetti
authors.forename: Franco
authors.initials: F
authors.lastname: Veglio
authors.forename: Sadayoshi
authors.initials: S
authors.lastname: Ito
authors.forename: Martin
authors.initials: M
authors.lastname: Reincke
authors.forename: Paolo
authors.initials: P
authors.lastname: Mulatero
mesh_terms: D000311:Adrenal Glands / Q000098:blood supply*; D000315:Adrenalectomy; D000450:Aldosterone / Q000097:blood*; D001794:Blood Pressure / Q000502:physiology*; D005260:Female; D006801:Humans; D006929:Hyperaldosteronism / Q000097:blood / Q000175:diagnosis / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000450:Aldosterone