Feasibility of imaging-guided adrenalectomy in young patients with primary aldosteronism

Rossi, G. P. et al. (2021) Feasibility of imaging-guided adrenalectomy in young patients with primary aldosteronism. Hypertension, 79(1), pp. 187-195. (doi: 10.1161/HYPERTENSIONAHA.121.18284) (PMID:34878892)

Abstract

Many of the patients with primary aldosteronism (PA) are denied curative adrenalectomy because of limited availability or failure of adrenal vein sampling. It has been suggested that adrenal vein sampling can be omitted in young patients with a unilateral adrenal nodule, who show a florid biochemical PA phenotype. As this suggestion was based on a very low quality of evidence, we tested the applicability and accuracy of imaging, performed by computed tomography and/or magnetic resonance, for identification of unilateral PA, as determined by biochemical and/or clinical cure after unilateral adrenalectomy. Among 1625 patients with PA submitted to adrenal vein sampling in a multicenter multiethnic international study, 473 were ≤45 years of age; 231 of them had exhaustive imaging and follow-up data. Fifty-three percentage had a unilateral adrenal nodule, 43% had no nodules, and 4% bilateral nodules. Fifty-six percentage (n=131) received adrenalectomy and 128 were unambiguously diagnosed as unilateral PA. A unilateral adrenal nodule on imaging and hypokalemia were the strongest predictors of unilateral PA at regression analysis. Accordingly, imaging allowed correct identification of the responsible adrenal in 95% of the adrenalectomized patients with a unilateral nodule. The rate raised to 100% in the patients with hypokalemia, who comprised 29% of the total, but fell to 88% in those without hypokalemia. Therefore, a unilateral nodule and hypokalemia could be used to identify unilateral PA in patients ≤45 years of age if adrenal vein sampling is not easily available. However, adrenal vein sampling remains indispensable in 71% of the young patients, who showed no nodules/bilateral nodules at imaging and/or no hypokalemia. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT01234220.

• Item Type: Articles
• Additional Information: This study was supported in part by research grants to G.P. Rossi from FORICA (The Foundation for advanced Research In Hypertension and CArdiovascular diseases) and from the Else Kröner-Fresenius-Stiftung to M. Reincke. A. Riester, M. Reincke, and J. Deinum received support from the Deutsche Forschungsgemeinschaft (DGE, German Research Foundation, Projektnummer 314061271-TRR 205); from the Japan Agency for Medical Research and Development (AMED) (JP20ek0109352) to M. Naruse; from the National Center for Global Health and Medicine, Japan (27-1402, 30-1008) to A. Tanabe.
• Keywords: Diagnosis, hypokalemia, aldosterone, phenotype, hypertension.
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Rossitto, Dr Giacomo
• Authors: Rossi, G. P., Crimì, F., Rossitto, G., Amar, L., Azizi, M., Riester, A., Reincke, M., Degenhart, C., Widimsky, J., Naruse, M., Deinum, J., Kool, L. S., Kocjan, T., Negro, A., Rossi, E., Kline, G., Tanabe, A., Satoh, F., Rump, L. C., Vonend, O., Willenberg, H. S., Fuller, P. J., Yang, J., Chee, N. Y. N., Magill, S. B., Shafigullina, Z., Quinkler, M., Oliveras, A., Wu, V. C., Kratka, Z., Barbiero, G., Battistel, M., and Seccia, T. M.
• College/School: College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health
• Journal Name: Hypertension
• Publisher: American Heart Association
• ISSN: 0194-911X
• ISSN (Online): 1524-4563
• Published Online: 17 November 2021