Subtyping of primary aldosteronism in the AVIS-2 study: assessment of selectivity and lateralization

Rossitto, G. et al. (2020) Subtyping of primary aldosteronism in the AVIS-2 study: assessment of selectivity and lateralization. Journal of Clinical Endocrinology and Metabolism, 105(6), pp. 2042-2052. (doi: 10.1210/clinem/dgz017) (PMID:31536622)

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Context: Adrenal venous sampling (AVS) is the key test for subtyping primary aldosteronism (PA), but its interpretation varies widely across referral centers and this can adversely affect the management of PA patients. Objectives: To investigate in a real life study the rate of bilateral success, identification of unilateral aldosteronism and blood pressure outcomes in PA subtyped by AVS. Design and settings: in a retrospective analysis of the largest international registry of individual AVS data (AVIS-2 study) we investigated how different cut-off values of the selectivity (SI) and lateralization index (LI) affected rate of bilateral success, identification of unilateral aldosteronism and blood pressure outcomes. Results: AVIS-2 recruited 1625 individual AVS studies performed between 2000 and 2015 in 19 tertiary referral centers. Under unstimulated conditions, the rate of biochemically confirmed bilateral AVS success progressively decreased with increasing SI cut-offs; furthermore, with currently used LI cut-offs the rate of identified unilateral PA leading to adrenalectomy was as low as < 25%. A within-patient pairwise comparison of 402 AVS performed both under unstimulated and cosyntropin-stimulation conditions showed that cosyntropin increased the confirmed rate of bilateral selectivity for SI cut-offs ≥ 2.0, but with reduced lateralization rates (p < 0.001). Post-adrenalectomy outcomes were not improved by use of cosyntropin or more restrictive diagnostic criteria. Conclusion: Commonly used SI and LI cut-offs are associated with disappointingly low rates of biochemically defined AVS success and identified unilateral PA. Evidence-based protocols entailing less restrictive interpretative cut-offs might optimize the clinical use of this costly and invasive test.

Item Type:Articles
Additional Information:Funding: This study was supported in part by research grants to GPR from FORICA (The FOundation for advanced Research In Hypertension and CArdiovascular diseases) and the Società Italiana dell’Ipertensione Arteriosa; from the Else Kröner-Fresenius-Stiftung to M.R. JD received support from the Deutsche Forschungsgemeinschaft (DGE, German Research Foundation, Projektnummer 314061271-TRR 205’.
Glasgow Author(s) Enlighten ID:Rossitto, Dr Giacomo
Authors: Rossitto, G., Amar, L., Azizi, M., Riester, A., Reincke, M., Degenhart, C., Widimsky, J., Mitsuhide, N., Deinum, J., Schultzekool, L., Kocjan, T., Negro, A., Rossi, E., Kline, G., Tanabe, A., Satoh, F., Rump, L. C., Vonend, O., Willenberg, H. S., Fuller, P., Yang, J., Chee, N. Y. N., Magill, S. B., Shafigullina, Z., Quinkler, M., Oliveras, A., Chang, C.-C., Wu, V. C., Somloova, Z., Maiolino, G., Barbiero, G., Battistel, M., Lenzini, L., Quaia, E., Pessina, A. C., and Rossi, G. P.
College/School:College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health
Journal Name:Journal of Clinical Endocrinology and Metabolism
Publisher:Oxford University Press
ISSN (Online):1945-7197
Published Online:20 September 2019
Copyright Holders:Copyright © Endocrine Society 2019
First Published:First published in Journal of Clinical Endocrinology and Metabolism 105(6):2042-2052
Publisher Policy:Reproduced in accordance with the publisher copyright policy

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