Importance of contralateral aldosterone suppression during adrenal vein sampling in the subtype evaluation of primary aldosteronism.
OBJECTIVE
Adrenal vein sampling (AVS) is the standard criterion for the subtype diagnosis in primary aldosteronism (PA). Although lateralized index (LI) ≥4 after cosyntropin stimulation is the commonly recommended cut-off for unilateral aldosterone hypersecretion, many of the referral centres in the world use LI cut-off of <4 without sufficient evidence for its diagnostic accuracy.


OBJECTIVE
The aim of the study was to establish the diagnostic significance of contralateral (CL) aldosterone suppression for the subtype diagnosis in patients with LI <4 in AVS.


METHODS
A retrospective multicentre study was conducted in Japan. Of 124 PA patients subjected to unilateral adrenalectomy after successful AVS with cosyntropin administration, 29 patients with LI < 4 were included in the study. The patients were divided into Group A with CL suppression (n = 16) and Group B (n = 13) without CL suppression. Three outcome indices were assessed after 6 months postoperatively: normalization/significant improvement of hypertension, normalization of the aldosterone to renin ratio (ARR) and normalization of hypokalaemia.


RESULTS
The normalization/significant improvement of hypertension was 81% in Group A and 54% in Group B (P = 0·2). The normalization of ARR was 100% in Group A and 46% in Group B (P = 0·004). Hypokalaemia was normalized in all patients of both groups. The overall cure rate of PA based on meeting all the three criteria was 81% in Group A and 31% in Group B (P = 0·01).


CONCLUSIONS
In patients with PA, where the LI is <4 on AVS, CL suppression of aldosterone is an accurate predictor of a unilateral source of aldosterone excess. CL suppression data should be interpreted in conjunction with computed tomographic adrenal imaging findings to guide surgical management.
Department of Endocrinology, Metabolism, and Hypertension, National Hospital Organization Kyoto Medical Center, Kyoto, Japan.
Hironobu
H
Umakoshi
Department of Endocrinology, Metabolism, and Hypertension, National Hospital Organization Kyoto Medical Center, Kyoto, Japan.
Kanako
K
Tanase-Nakao
Department of Diabetes and Endocrinology, Sapporo City Hospital, Sapporo, Japan.
Norio
N
Wada
Department of Diabetes and Endocrinology, Saiseikai Yokohama City Toubu Hospital, Yokohama, Japan.
Takamasa
T
Ichijo
Department of Diabetes, Endocrinology, and Nutrition, Kyoto University Graduate School of Medicine, Kyoto, Japan.
Masakatsu
M
Sone
Department of Diabetes, Endocrinology, and Nutrition, Kyoto University Graduate School of Medicine, Kyoto, Japan.
Nobuya
N
Inagaki
Department of Endocrinology and Metabolism, Yokohama City Seibu Hospital, St. Marianna University School of Medicine, Yokohama, Japan.
Takuyuki
T
Katabami
Department of Cardiology, Akashi Medical Center, Akashi, Japan.
Kohei
K
Kamemura
Department of Cardiology, Sanda City Hospital, Sanda, Japan.
Yuichi
Y
Matsuda
Department of Cardiology, Hiroshima General Hospital of West Japan Railway Company, Hiroshima, Japan.
Yuichi
Y
Fujii
Department of Cardiology, Saiseikai Tondabayashi Hospital, Tondabayashi, Japan.
Tatsuya
T
Kai
Department of Internal Medicine, Matsuyama Red Cross Hospital, Matsuyama, Japan.
Tomikazu
T
Fukuoka
Department of Endocrinology and Metabolism, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan.
Ryuichi
R
Sakamoto
Department of Endocrinology and Metabolism, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan.
Atsushi
A
Ogo
Department of Public Health, Kitasato University School of Medicine, Tokyo, Japan.
Tomoko
T
Suzuki
Department of Endocrinology, Metabolism, and Hypertension, National Hospital Organization Kyoto Medical Center, Kyoto, Japan.
Mika
M
Tsuiki
Department of Endocrinology, Metabolism, and Hypertension, National Hospital Organization Kyoto Medical Center, Kyoto, Japan.
Akira
A
Shimatsu
Department of Endocrinology, Metabolism, and Hypertension, National Hospital Organization Kyoto Medical Center, Kyoto, Japan.
Mitsuhide
M
Naruse
D000450:Aldosterone / Q000097:blood*; D005260:Female; D006801:Humans; D006929:Hyperaldosteronism / Q000097:blood* / Q000175:diagnosis*; D006973:Hypertension / Q000097:blood / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
D000450:Aldosterone