title: Outcome of adrenal vein sampling performed during concurrent mineralocorticoid receptor antagonist therapy.
abstract: BACKGROUND
  Pharmacological inhibition of mineralocorticoid receptor (MR) signaling in patients with primary aldosteronism (PA) reestablishes aldosterone synthesis by nondiseased zona glomerulosa cells through activation of the renin-angiotensin-aldosterone system. In this context, current guidelines recommend discontinuing MR blockade for diagnostic procedures, including adrenal vein sampling (AVS). Discontinuation of MR blockade in high-risk patients may be harmful because of uncontrolled hypertension and severe hypokalemia. We hypothesize that MR antagonist therapy can be continued during AVS as long as renin levels remain suppressed.
  
  
  OBJECTIVE
  The objective of this study was to assess the validity of AVS results in the context of MR antagonistic therapy.
  
  
  METHODS
  We retrospectively analyzed all AVS studies in Munich (since 2008) and Düsseldorf (since 2011) and identified four of 237 (1.7%) patients with PA who underwent AVS while treated with an MR antagonist. Adrenalectomy was recommended based on the results of AVS in all four patients. After adrenalectomy, follow-up data were obtained to confirm improvement or remission of PA. Main outcome measures included blood pressure values, daily defined doses of antihypertensive medication, as well as levels of aldosterone, renin, and potassium, and the aldosterone/renin ratio.
  
  
  RESULTS
  In all patients, renin remained low or suppressed during AVS despite MR antagonist treatment. AVS clearly demonstrated unilateral aldosterone excess in each case. After adrenalectomy, all patients showed remission of PA as demonstrated by blood pressure values, potassium levels, and the aldosterone/renin ratio.
  
  
  CONCLUSIONS
  In selected cases of PA, MR antagonist therapy might be continued during AVS, provided that renin values remain low.
authors.affiliation: Division for Specific Endocrinology (M.H., H.S.W.), and Department of Diagnostic and Interventional Radiology (P.K.), Medical Faculty, University Duesseldorf, D-40225 Duesseldorf, Germany; Medizinische Klinik und Poliklinik IV (A.R., M.R.), and Department of Radiology (C.D.), Hospital of the Ludwig Maximilians University, D-80336 Munich, Germany; and Endocrinology and Diabetes Unit (S.H.), Department of Medicine I, University Hospital Wuerzburg, D-97080 Wuerzburg, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Haase
authors.forename: Anna
authors.initials: A
authors.lastname: Riester
authors.forename: Patric
authors.initials: P
authors.lastname: Kröpil
authors.forename: Stefanie
authors.initials: S
authors.lastname: Hahner
authors.forename: Christoph
authors.initials: C
authors.lastname: Degenhart
authors.forename: Holger S
authors.initials: HS
authors.lastname: Willenberg
authors.forename: Martin
authors.initials: M
authors.lastname: Reincke
mesh_terms: D000311:Adrenal Glands / Q000098:blood supply / Q000473:pathology*; D000315:Adrenalectomy; D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use; D005260:Female; D006801:Humans; D006929:Hyperaldosteronism / Q000188:drug therapy* / Q000473:pathology*; D006973:Hypertension / Q000188:drug therapy / Q000209:etiology; D008297:Male; D008875:Middle Aged; D000451:Mineralocorticoid Receptor Antagonists / Q000627:therapeutic use*; D012083:Renin / Q000097:blood; D015203:Reproducibility of Results; D014680:Veins / Q000473:pathology
chemical_list: D000959:Antihypertensive Agents; D000451:Mineralocorticoid Receptor Antagonists; D012083:Renin