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Liu JH, Huang WC, Hu J, Hong N, Rhee Y, Li Q, Chen CM, Chueh JS, Lin YH, Wu VC. Validating Machine Learning Models Against the Saline Test Gold Standard for Primary Aldosteronism Diagnosis. JACC. ASIA 2024; 4:972-984. [PMID: 39802987 PMCID: PMC11712017 DOI: 10.1016/j.jacasi.2024.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/04/2024] [Accepted: 09/09/2024] [Indexed: 01/16/2025]
Abstract
Background In this study, we developed and validated machine learning models to predict primary aldosteronism (PA) in hypertensive East-Asian patients, comparing their performance against the traditional saline infusion test. The motivation for this development arises from the need to provide a more efficient and standardized diagnostic approach, because the saline infusion test, although considered a gold standard, is often cumbersome, is time-consuming, and lacks uniform protocols. By offering an alternative diagnostic method, this study seeks to enhance patient care through quicker and potentially more reliable PA detection. Objectives This study sought to both develop and evaluate the performance of machine learning models in detecting PA among hypertensive participants, in comparison to the standard saline loading test. Methods We used patient data from 3 distinct cohorts: TAIPAI (Taiwan Primary Aldosteronism Investigation), CONPASS (Chongqing Primary Aldosteronism Study), and a South Korean cohort. Random Forest's importance scores, XGBoost, and deep learning techniques are adopted to identify the most predictive features of primary aldosteronism. Results We present detailed results of the model's performance, including accuracy, sensitivity, and specificity. The Random Forest model achieved an accuracy of 0.673 (95% CI: 0.640-0.707), significantly outperforming the baseline models. Conclusions In our discussion, we address both the strengths and limitations of our study. Although the machine learning models demonstrated superior performance in predicting primary aldosteronism, the generalizability of these findings may be limited to East-Asian hypertensive populations. Future studies are needed to validate these models in diverse demographic settings to enhance their applicability.
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Affiliation(s)
- Jung-Hua Liu
- Department of Communication, National Chung Cheng University, Chiayi, Taiwan
| | - Wei-Chieh Huang
- Division of Cardiology, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Jinbo Hu
- Department of Endocrinology, the First Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Namki Hong
- Division of Endocrinology and Metabolism, Yonsei University College of Medicine, Seoul, South Korea
- Institute for Innovation in Digital Healthcare, Yonsei University, Seodaemun-gu, Seoul, South Korea
| | - Yumie Rhee
- Division of Endocrinology and Metabolism, Yonsei University College of Medicine, Seoul, South Korea
| | - Qifu Li
- Department of Endocrinology, the First Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Chung-Ming Chen
- Department of Biomedical Engineering, National Taiwan University, Taipei, Taiwan
| | - Jeff S. Chueh
- Department of Urology, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Yen-Hung Lin
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
- Primary Aldosteronism Center in National Taiwan University Hospital, TAIPAI (Taiwan Primary Aldosteronism Investigation) Study Group, Taiwan
| | - Vin-Cent Wu
- Primary Aldosteronism Center in National Taiwan University Hospital, TAIPAI (Taiwan Primary Aldosteronism Investigation) Study Group, Taiwan
- Division of Nephrology, Primary Aldosteronism Center of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
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Cai R, Hu C, Li HY. Cone-beam computed tomography is not a mandatory procedure in adrenal venous sampling for primary hyperaldosteronism. BMC Med Imaging 2022; 22:189. [PMID: 36329393 PMCID: PMC9635157 DOI: 10.1186/s12880-022-00911-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 10/13/2022] [Indexed: 11/06/2022] Open
Abstract
Objectives To investigate the necessity of cone-beam computed tomography (CBCT) in adrenal venous sampling (AVS). Methods This retrospective study included 120 consecutive patients with primary hyperaldosteronism who underwent AVS. Based on the learning curve of the interventional radiologists, the patients were divided into the learning (n = 36) and proficiency (n = 84) groups chronologically. Based on the imaging pattern of the right adrenal vein (RAV), the patients were divided into the typical (n = 36) and atypical (n = 84) groups. The success rate, radiation dose, and sampling time were compared among the entire study population and each subgroup. Results A total of 69 patients underwent CBCT, whereas 51 patients did not. The overall success rate was 85.8%, and no difference was noted between patients with and without CBCT (P = 0.347). However, radiation dose (P = 0.018) and sampling time (P = 0.001) were significantly higher in patients who underwent CBCT than in patients who did not. In learning group, CBCT improved success rate from 62.5 to 96.4% (P = 0.028), whereas it was not found in the proficiency group (P = 0.693). Additionally, success rate in patients with an atypical RAV imaging pattern was significantly higher when CBCT was used than when it was not used (P = 0.041), whereas no difference was noted in patients with typical RAV imaging pattern (P = 0.511). Conclusion For physicians not very experienced doing AVS, there is a clear significant improvement in success rate when CBCT is used. However, CBCT only has minimal benefit for experienced operators, meanwhile CBCT may take an extra time and increase the radiation dose during AVS.
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Yoon M, Hong N, Ha J, Lee CJ, Ku CR, Rhee Y, Park S. Prevalence and clinical characteristics of primary aldosteronism in a tertiary-care center in Korea. Hypertens Res 2022; 45:1418-1429. [PMID: 35681044 DOI: 10.1038/s41440-022-00948-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 05/11/2022] [Accepted: 05/13/2022] [Indexed: 11/08/2022]
Abstract
Approximately 29% of Korean adults have hypertension; however, the prevalence of primary aldosteronism among the hypertensive population is largely unknown. The aim of our study was to evaluate the prevalence and clinical characteristics of primary aldosteronism in a tertiary-care center in Korea. We retrospectively analyzed 1173 patients with newly diagnosed or preexisting hypertension who were referred to our tertiary-care hospital between January 2013 and December 2018. Patients were screened for primary aldosteronism with the aldosterone-renin ratio and underwent a saline infusion test for diagnostic confirmation. Adrenal computed tomography and adrenal venous sampling were performed for subtype classification for primary aldosteronism. Among the 1173 patients (mean age, 51.8 years; women, 53.2%), 360 (30.7%) had positive screening-test results, of whom 71 (6.1%) were finally diagnosed with primary aldosteronism. Conclusive subtype differentiation was made in 55 patients, of whom 15 (27%) had an aldosterone-producing adenoma, 4 (7%) had unilateral adrenal hyperplasia, and 36 (66%) had bilateral adrenal hyperplasia. Patients with primary aldosteronism had a higher ambulatory blood pressure, left ventricular mass index, and urinary albumin-to-creatinine ratio than those without. Moreover, the primary aldosteronism group had a higher prevalence of left ventricular hypertrophy and albuminuria than the non-primary aldosteronism group. Primary aldosteronism may be more common (6.1%) among Korean patients with hypertension than generally recognized. Primary aldosteronism was associated with a higher degree and prevalence of target organ damage and a higher blood pressure level. Wide application of screening tests for primary aldosteronism may be beneficial in detecting this potentially curable cause of hypertension.
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Affiliation(s)
- Minjae Yoon
- Division of Cardiology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
- Division of Cardiology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Namki Hong
- Department of Internal Medicine, Endocrine Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jaehyung Ha
- Division of Cardiology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Chan Joo Lee
- Division of Cardiology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Cheol Ryong Ku
- Department of Internal Medicine, Endocrine Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yumie Rhee
- Department of Internal Medicine, Endocrine Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
| | - Sungha Park
- Division of Cardiology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
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Becker LS, Hinrichs MH, Werncke T, Dewald CLA, Maschke SK, Limbourg FP, Ringe KI, Hinrichs JB, Wacker F, Meyer BC. Adrenal venous sampling in primary hyperaldosteronism: correlation of hormone indices and collimated C-arm CT findings. Abdom Radiol (NY) 2021; 46:3471-3481. [PMID: 33674958 PMCID: PMC8215038 DOI: 10.1007/s00261-021-03003-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 02/10/2021] [Accepted: 02/13/2021] [Indexed: 01/08/2023]
Abstract
PURPOSE To evaluate the feasibility and effect of an approach to adrenal venous sampling (AVS) analysis by combining established selective cortisol and aldosterone indices with the acquisition of a collimated C-arm CT(CACTColl). METHODS Overall, 107 consecutive patients (45f,62 m; 54 ± 10 years) undergoing 111 AVS procedures without hormonal stimulation from 7/13 to 2/20 in a single institution were retrospectively analysed. Hormone levels were measured in sequential samples of the suspected adrenal veins and right iliac vein, and selectivity indices (SI) computed. Stand-alone SICortisol and/or SIAldosterone ≥ 2.0 as well as SICortisol and/or SIAldosterone ≥ 1.1 combined with positive right-sided CACTColl of the adrenals (n = 80; opacified right adrenal vein) were defined as a successful AVS procedure. Radiation exposure of CACT was measured via dose area product (DAP) and weighed against an age-/weight-matched cohort (n = 66). RESULTS Preliminary success rates (SICortisol and/or SIAldosterone ≥ 2.0) were 99.1% (left) and 72.1% (right). These could be significantly increased to a 90.1% success rate on the right, by combining an adjusted SI of 1.1 with a positive CACTColl proving the correct sampling position. Sensitivity for stand-alone collimated CACT (CACTColl) was 0.93, with 74/80 acquired CACTColl confirming selective cannulation by adrenal vein enhancement. Mean DAPColl_CACT measured 2414 ± 958 μGyxm2, while mean DAPFull-FOV_CACT in the matched cohort measured 8766 ± 1956 μGyxm2 (p < 0.001). CONCLUSION Collimated CACT in AVS procedures is feasible and leads to a significant increase in success rates of (right-sided) selective cannulation and may in combination with adapted hormone indices, offer a successful alternative to previously published AVS analysis algorithms with lower radiation exposure compared to a full-FOV CACT.
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Affiliation(s)
- L S Becker
- Department of Diagnostic and Interventional Radiology, Institute for Diagnostic and Interventional Radiology, Hannover Medical School, OE8220, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
| | - M H Hinrichs
- Department of Diagnostic and Interventional Radiology, Institute for Diagnostic and Interventional Radiology, Hannover Medical School, OE8220, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - T Werncke
- Department of Diagnostic and Interventional Radiology, Institute for Diagnostic and Interventional Radiology, Hannover Medical School, OE8220, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - C L A Dewald
- Department of Diagnostic and Interventional Radiology, Institute for Diagnostic and Interventional Radiology, Hannover Medical School, OE8220, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - S K Maschke
- Department of Diagnostic and Interventional Radiology, Institute for Diagnostic and Interventional Radiology, Hannover Medical School, OE8220, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - F P Limbourg
- Department of Nephrology and Hypertension, Hannover Medical School, Hannover, Germany
| | - K I Ringe
- Department of Diagnostic and Interventional Radiology, Institute for Diagnostic and Interventional Radiology, Hannover Medical School, OE8220, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - J B Hinrichs
- Department of Diagnostic and Interventional Radiology, Institute for Diagnostic and Interventional Radiology, Hannover Medical School, OE8220, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - F Wacker
- Department of Diagnostic and Interventional Radiology, Institute for Diagnostic and Interventional Radiology, Hannover Medical School, OE8220, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - B C Meyer
- Department of Diagnostic and Interventional Radiology, Institute for Diagnostic and Interventional Radiology, Hannover Medical School, OE8220, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
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Lee SE, Park SW, Choi MS, Kim G, Yoo JH, Ahn J, Jun JE, Park HS, Hyun D, Cho SK, Ko SE, Kim BJ, Kim JW, Yoon HK, Koh JM, Lee SH, Kim JH. Primary aldosteronism subtyping in the setting of partially successful adrenal vein sampling. Ther Adv Endocrinol Metab 2021; 12:2042018821989239. [PMID: 33633828 PMCID: PMC7887669 DOI: 10.1177/2042018821989239] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 01/03/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND AIMS Frequent failure of adrenal vein (AV) cannulation is a major obstacle to the universal use of adrenal vein sampling (AVS) for subtyping primary aldosteronism (PA). This study aimed to confirm and modify the value of a previously reported AVS parameter for PA subtyping in the case of cannulation failure on one side. METHODS Successfully catheterized AVS studies in 157 patients (121 patients as a derivation cohort and 36 patients as a validation cohort) from two tertiary hospitals were retrospectively reviewed. The AV/inferior vena cava (IVC) index was defined by dividing the aldosterone/cortisol ratio (ACR) of AV by the ACR of the IVC. Cutoff values for lateralized PA were obtained from two methods: scatterplots and the values corresponding to Youden's index in receiver operating characteristic (ROC) curves, on the assumption of catheterization failure on one side. RESULTS Due to multiple samplings in a single AVS procedure, 252 left AV/IVC ratios (LIRs) and 272 right AV/IVC ratios (RIRs) were calculated. Scatterplot cutoffs of LIR >5.4 or <0.5 predicted unilateral PA with a sensitivity of 42.1% and a specificity of 98.6%. Scatterplot cutoffs of RIR <0.5 or >7.0 showed a sensitivity of 55.1% and a specificity of 98.6%. ROC curve cutoffs of LIR ⩽0.8 or >3.1 predicted unilateral PA with a sensitivity of 82.5% and a specificity of 69.6%. ROC curve cutoffs of RIR ⩽0.8 or >3.9 resulted in 87.4% sensitivity and 80.7% specificity. CONCLUSION In the case of unilateral AVS failure, the AV/IVC index may help in diagnosing PA subtype.
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Affiliation(s)
- Seung-Eun Lee
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Gangnam-gu, Seoul, Republic of Korea
| | - Sung Woon Park
- Division of Endocrinology and Metabolism, Department of Internal Medicine, CHA Gangnam Medical Center, CHA University, Gangnam-gu, Seoul, Republic of Korea
| | - Min Sun Choi
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Gangnam-gu, Seoul, Republic of Korea
| | - Gyuri Kim
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Gangnam-gu, Seoul, Republic of Korea
| | - Jee Hee Yoo
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju-si, Gangwon-do, Republic of Korea
| | - Jiyeon Ahn
- Division of Endocrinology and Metabolism, Department of Medicine, Myongji Hospital, Deogyang-gu, Goyang-si, Gyeonggi-do, Republic of Korea
| | - Ji Eun Jun
- Department of Endocrinology and Metabolism, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Gangdong-gu, Seoul, Republic of Korea
| | - Hong Suk Park
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Gangnam-gu, Seoul, Republic of Korea
| | - Dongho Hyun
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Gangnam-gu, Seoul, Republic of Korea
| | - Sung Ki Cho
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Gangnam-gu, Seoul, Republic of Korea
| | - Seong Eun Ko
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Gangnam-gu, Seoul, Republic of Korea
| | - Beom-Jun Kim
- Division of Endocrinology and Metabolism, Department of Medicine, Asan Medical Center, University of Ulsan College of Medicine, Songpa-gu, Seoul, Republic of Korea
| | - Jong Woo Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Songpa-gu, Seoul, Republic of Korea
| | - Hyun-Ki Yoon
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Songpa-gu, Seoul, Republic of Korea
| | - Jung-Min Koh
- Division of Endocrinology and Metabolism, Department of Medicine, Asan Medical Center, University of Ulsan College of Medicine, Songpa-gu, Seoul, Republic of Korea
| | - Seung Hun Lee
- Division of Endocrinology and Metabolism, Department of Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, Republic of Korea
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Meyrignac O, Arcis É, Delchier MC, Mokrane FZ, Darcourt J, Rousseau H, Bouhanick B. Impact of cone beam - CT on adrenal vein sampling in primary aldosteronism. Eur J Radiol 2020; 124:108792. [DOI: 10.1016/j.ejrad.2019.108792] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 11/20/2019] [Accepted: 12/11/2019] [Indexed: 10/25/2022]
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Nakayama K, Shimohira M, Nakagawa M, Ozawa Y, Sawada Y, Ohta K, Ohashi K, Shibamoto Y. Advanced monoenergetic reconstruction technique in dual-energy computed tomography for evaluation of vascular anatomy before adrenal vein sampling. Acta Radiol 2020; 61:282-288. [PMID: 31280588 DOI: 10.1177/0284185119860226] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background In adrenal vein sampling, selecting the right adrenal vein is technically difficult and it is important to evaluate the right adrenal vein anatomy before adrenal vein sampling. The advanced monoenergetic reconstruction technique has recently become available and we hypothesized that this technique may be useful. Purpose To evaluate the usefulness of the advanced monoenergetic reconstruction technique in dual-energy computed tomography (CT; advanced monoenergetic images) for evaluation of vascular anatomy before adrenal vein sampling. Material and Methods Twenty-one patients underwent three-phase (20, 30, and 70 s) contrast-enhanced CT before adrenal vein sampling. Advanced monoenergetic images were reconstructed at 40 keV and analyzed objectively and subjectively in comparison with the standard 120-kVp images. As objective evaluation, the signal-to-noise ratio and contrast-to-noise ratio of the right adrenal vein were assessed. As subjective evaluation, two radiologists assessed the delineation of the right adrenal vein using a 5-point Likert scale (1 = poor, 5 = excellent). Furthermore, the technical success rate of adrenal vein sampling and procedure time were also evaluated. Results There was no difference in the signal-to-noise ratio between the two groups. The contrast-to-noise ratios of the right adrenal vein of advanced monoenergetic images were higher than those of the standard images ( P < 0.05). The Likert scores of advanced monoenergetic images were higher than those of the standard images ( P < 0.05). The technical success rate of adrenal vein sampling was 95% (20/21) and the median of procedure time was 103 min (range = 59–197 min). Conclusion Advanced monoenergetic imaging appears to be useful in the delineation of the right adrenal vein before adrenal vein sampling.
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Affiliation(s)
- Keita Nakayama
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Masashi Shimohira
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Motoo Nakagawa
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Yoshiyuki Ozawa
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Yusuke Sawada
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Kengo Ohta
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Kazuya Ohashi
- Central Division of Radiology, Nagoya City University Hospital, Nagoya, Japan
| | - Yuta Shibamoto
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
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Kim K, Kim JK, Lee CR, Kang SW, Lee J, Jeong JJ, Nam KH, Chung WY. Surgical outcomes of laparoscopic adrenalectomy for primary hyperaldosteronism: 20 years of experience in a single institution. Ann Surg Treat Res 2019; 96:223-229. [PMID: 31073512 PMCID: PMC6483932 DOI: 10.4174/astr.2019.96.5.223] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 12/28/2018] [Accepted: 01/29/2019] [Indexed: 11/30/2022] Open
Abstract
Purpose Recently, posterior retroperitoneoscopic adrenalectomy (PRA) has been reported to have some advantages over laparoscopic transperitoneal adrenalectomy (LTA). The objectives of this study were to report our experience over 12 years with laparoscopic adrenalectomy for primary hyperaldosteronism (PHA) and to examine surgical outcomes of PRA compared with LTA in patients with PHA. Methods The medical records of 527 patients who underwent minimally invasive adrenalectomy, including LTA or PRA, from January 2006 until May 2017 were reviewed at Severance Hospital (Seoul, Korea). Clinicopathologic characteristics and surgical outcomes of 146 patients with PHA who underwent LTA (19 patients) or PRA (127 patients) were analyzed retrospectively by complete chart review. Results The overall rates of biochemical and clinical cure were 91.1% and 93.1%, respectively. The mean operation time of the PRA group was significantly shorter than that of the LTA group (72.3 ± 24.1 minutes vs. 115.7 ± 69.7 minutes, P = 0.015). The length of hospital stay in the PRA group was significantly shorter than in the LTA group (3.5 ± 1.3 days vs. 4.2 ± 1.6 days, P = 0.029), and the first meal after surgery came earlier in the PRA group (0.3 ± 0.5 days vs. 0.6 ± 0.5 days, P = 0.049). The number of pain-killers used was also significantly smaller in the PRA group (2.3 ± 2.1 vs. 4.3 ± 2.3, P < 0.001). Conclusion PRA offers an alternative or likely superior method for treatment of small adrenal diseases such as PHA, with improved surgical outcomes.
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Affiliation(s)
- Kwangsoon Kim
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Jin Kyong Kim
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Cho Rok Lee
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Sang-Wook Kang
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Jandee Lee
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Jong Ju Jeong
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Kee-Hyun Nam
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Woong Youn Chung
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
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Advantages of Intraprocedural Unenhanced CT During Adrenal Venous Sampling to Confirm Accurate Catheterization of the Right Adrenal Vein. Cardiovasc Intervent Radiol 2018; 42:542-551. [DOI: 10.1007/s00270-018-2135-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Accepted: 11/25/2018] [Indexed: 10/27/2022]
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Lim JS, Hong N, Park S, Park SI, Oh YT, Yu MH, Lim PY, Rhee Y. Effects of Altered Calcium Metabolism on Cardiac Parameters in Primary Aldosteronism. Endocrinol Metab (Seoul) 2018; 33:485-492. [PMID: 30513563 PMCID: PMC6279903 DOI: 10.3803/enm.2018.33.4.485] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 10/14/2018] [Accepted: 11/05/2018] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Increasing evidence supports interplay between aldosterone and parathyroid hormone (PTH), which may aggravate cardiovascular complications in various heart diseases. Negative structural cardiovascular remodeling by primary aldosteronism (PA) is also suspected to be associated with changes in calcium levels. However, to date, few clinical studies have examined how changes in calcium and PTH levels influence cardiovascular outcomes in PA patients. Therefore, we investigated the impact of altered calcium homeostasis caused by excessive aldosterone on cardiovascular parameters in patients with PA. METHODS Forty-two patients (mean age 48.8±10.9 years; 1:1, male:female) whose plasma aldosterone concentration/plasma renin activity ratio was more than 30 were selected among those who had visited Severance Hospital from 2010 to 2014. All patients underwent adrenal venous sampling with complete access to both adrenal veins. RESULTS The prevalence of unilateral adrenal adenoma (54.8%) was similar to that of bilateral adrenal hyperplasia. Mean serum corrected calcium level was 8.9±0.3 mg/dL (range, 8.3 to 9.9). The corrected calcium level had a negative linear correlation with left ventricular end-diastolic diameter (LVEDD, ρ=-0.424, P=0.031). Moreover, multivariable regression analysis showed that the corrected calcium level was marginally associated with the LVEDD and corrected QT (QTc) interval (β=-0.366, P=0.068 and β=-0.252, P=0.070, respectively). CONCLUSION Aldosterone-mediated hypercalciuria and subsequent hypocalcemia may be partly involved in the development of cardiac remodeling as well as a prolonged QTc interval, in subjects with PA, thereby triggering deleterious effects on target organs additively.
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Affiliation(s)
- Jung Soo Lim
- Department of Internal Medicine, Institute of Evidence Based Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Namki Hong
- Department of Internal Medicine, Severance Hospital, Endocrine Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Sungha Park
- Division of Cardiology, Severance Cardiovascular Hospital and Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Sung Il Park
- Department of Radiology, Inje University Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Young Taik Oh
- Department of Radiology, Yonsei University College of Medicine, Seoul, Korea
| | - Min Heui Yu
- Department of Biostatistics, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Pil Yong Lim
- Hwacheon Public Health and Medical Care Center, Hwacheon, Korea
| | - Yumie Rhee
- Department of Internal Medicine, Severance Hospital, Endocrine Research Institute, Yonsei University College of Medicine, Seoul, Korea.
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Park CH, Hong N, Han K, Kang SW, Lee CR, Park S, Rhee Y. C-Arm Computed Tomography-Assisted Adrenal Venous Sampling Improved Right Adrenal Vein Cannulation and Sampling Quality in Primary Aldosteronism. Endocrinol Metab (Seoul) 2018; 33:236-244. [PMID: 29766680 PMCID: PMC6021301 DOI: 10.3803/enm.2018.33.2.236] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 02/19/2018] [Accepted: 03/08/2018] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Adrenal venous sampling (AVS) is a gold standard for subtype classification of primary aldosteronism (PA). However, this procedure has a high failure rate because of the anatomical difficulties in accessing the right adrenal vein. We investigated whether C-arm computed tomography-assisted AVS (C-AVS) could improve the success rate of adrenal sampling. METHODS A total of 156 patients, diagnosed with PA who underwent AVS from May 2004 through April 2017, were included. Based on the medical records, we retrospectively compared the overall, left, and right catheterization success rates of adrenal veins during the periods without C-AVS (2004 to 2010, n=32) and with C-AVS (2011 to 2016, n=124). The primary outcome was adequate bilateral sampling defined as a selectivity index (SI) >5. RESULTS With C-AVS, the rates of adequate bilateral AVS increased from 40.6% to 88.7% (P<0.001), with substantial decreases in failure rates (43.7% to 0.8%, P<0.001). There were significant increases in adequate sampling rates from right (43.7% to 91.9%, P<0.001) and left adrenal veins (53.1% to 95.9%, P<0.001) as well as decreases in catheterization failure from right adrenal vein (9.3% to 0.0%, P<0.001). Net improvement of SI on right side remained significant after adjustment for left side (adjusted SI, 1.1 to 9.0; P=0.038). C-AVS was an independent predictor of adequate bilateral sampling in the multivariate model (odds ratio, 9.01; P<0.001). CONCLUSION C-AVS improved the overall success rate of AVS, possibly as a result of better catheterization of right adrenal vein.
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Affiliation(s)
- Chung Hyun Park
- Department of Internal Medicine, Endocrine Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Namki Hong
- Department of Internal Medicine, Endocrine Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Kichang Han
- Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
| | - Sang Wook Kang
- Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Cho Rok Lee
- Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Sungha Park
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Yumie Rhee
- Department of Internal Medicine, Endocrine Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
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Familial clustering of vitamin D deficiency via shared environment: The Korean National Health and Nutrition Examination Survey 2008–2012. Eur J Clin Nutr 2018; 72:1700-1708. [DOI: 10.1038/s41430-018-0157-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Revised: 02/23/2018] [Accepted: 02/28/2018] [Indexed: 01/08/2023]
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Abstract
Primary aldosteronism (PA) is now considered as one of leading causes of secondary hypertension, accounting for 5-10% of all hypertensive patients and more strikingly 20% of those with resistant hypertension. Importantly, those with the unilateral disease could be surgically cured when diagnosed appropriately. On the other hand, only a very limited portion of those suspected to have PA has been screened, diagnosed, or treated to date. With current advancement in medical technologies and genetic research, expanding knowledge of PA has been accumulated and recent achievements have also been documented in the care of those with PA. This review is aimed to have focused description on updated topics of the following; importance of PA screening both in the general and specialized settings and careful interpretation of screening data, recent achievements in hormone assays and sampling methods and their clinical relevance, and expanding knowledge on PA genetics. Improvement in workup processes and novel treatment options, as well as better understanding of the PA pathogenesis based on genetic research, might be expected to result in increased cure and better care of the patients.
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Affiliation(s)
- Ryo Morimoto
- Division of Nephrology, Endocrinology and Vascular Medicine, Department of Medicine, Tohoku University Hospital, Sendai, Miyagi, Japan
| | - Kei Omata
- Division of Nephrology, Endocrinology and Vascular Medicine, Department of Medicine, Tohoku University Hospital, Sendai, Miyagi, Japan
- Division of Clinical Hypertension, Endocrinology and Metabolism, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
- Department of Pathology, University of Michigan, Ann Arbor, Michigan, USA
| | - Sadayoshi Ito
- Division of Nephrology, Endocrinology and Vascular Medicine, Department of Medicine, Tohoku University Hospital, Sendai, Miyagi, Japan
| | - Fumitoshi Satoh
- Division of Nephrology, Endocrinology and Vascular Medicine, Department of Medicine, Tohoku University Hospital, Sendai, Miyagi, Japan
- Division of Clinical Hypertension, Endocrinology and Metabolism, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
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Yang J, Shen J, Fuller PJ. Diagnosing endocrine hypertension: a practical approach. Nephrology (Carlton) 2017; 22:663-677. [PMID: 28556585 DOI: 10.1111/nep.13078] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Revised: 05/10/2017] [Accepted: 05/24/2017] [Indexed: 12/16/2022]
Affiliation(s)
- Jun Yang
- Centre for Endocrinology and Metabolism; Hudson Institute of Medical Research; Melbourne Victoria Australia
- Department of Endocrinology; Monash Health; Melbourne Victoria Australia
| | - Jimmy Shen
- Centre for Endocrinology and Metabolism; Hudson Institute of Medical Research; Melbourne Victoria Australia
- Department of Endocrinology; Monash Health; Melbourne Victoria Australia
| | - Peter J. Fuller
- Centre for Endocrinology and Metabolism; Hudson Institute of Medical Research; Melbourne Victoria Australia
- Department of Endocrinology; Monash Health; Melbourne Victoria Australia
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Comparison of C-arm computed tomography and on-site quick cortisol assay for adrenal venous sampling: A retrospective study of 178 patients. Eur Radiol 2017; 27:5006-5014. [DOI: 10.1007/s00330-017-4930-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Revised: 05/07/2017] [Accepted: 06/07/2017] [Indexed: 10/19/2022]
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Cone-beam computed tomography with automated bone subtraction in preoperative embolization for pelvic bone tumors. PLoS One 2017; 12:e0175907. [PMID: 28419147 PMCID: PMC5395210 DOI: 10.1371/journal.pone.0175907] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 04/02/2017] [Indexed: 11/19/2022] Open
Abstract
PURPOSE To evaluate the usefulness of cone-beam computed tomography with automated bone subtraction (CBCT-ABS) in the preoperative embolization of hypervascular tumors located in the pelvic bone. MATERIALS AND METHODS This retrospective study included 26 patients with pelvic bone tumors who underwent preoperative embolization between January 2014 and October 2016. A CBCT-ABS scan was taken in a total of 17 patients (CBCT-ABS group), and only a series of digital subtraction angiographies (DSAs) was taken in the remaining 9 patients (DSA group). The percent devascularization, number of angiographic runs, total dose-area product (DAP), fluoroscopy time, interventional procedure time, operative time, and estimated blood loss were compared between the two groups using Mann-Whitney test. RESULTS The percent devascularization, interventional procedure time, fluoroscopy time, operative time, and estimated blood loss were not statistically different between the two groups (p > 0.05). On the other hand, the number of angiographic runs in the CBCT-ABS group was significantly lower than that in the DSA group (p = 0.029). The total DAP of the CBCT-ABS group (mean, 17700.7 μGym2) was higher than that of the DSA group (mean, 8939.4 μGym2) (p = 0.002). CONCLUSIONS The use of CBCT-ABS during the preoperative embolization of pelvic bone tumors significantly reduces the number of angiographic runs at the cost of an increased radiation dose.
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Adrenal hormones before and after venography during adrenal venous sampling: a self-controlled study. Jpn J Radiol 2017; 35:126-130. [PMID: 28074381 DOI: 10.1007/s11604-017-0612-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Accepted: 01/03/2017] [Indexed: 10/20/2022]
Abstract
OBJECTIVE A stress reaction involving increased adrenal hormone release occurs when starting adrenal venous sampling (AVS). The purpose of the present study was to investigate the effect of single shot venography on adrenal hormone production during AVS. SUBJECTS AND METHODS This was a prospective self-controlled study. We enrolled 54 consecutive patients (21 men, 33 women; mean age 52 ± 11 years) with primary aldosteronism who underwent AVS from May 2014 to February 2015. Under non-stimulated conditions, blood samples were obtained from a common trunk of the left adrenal vein before and after single shot venography. The initial plasma aldosterone and cortisol concentration (PAC and PCC) were compared with those measured after venography for each patient. RESULTS PAC and PCC were slightly but significantly decreased between before and after venography (after log transformation 2.12 ± 0.73 vs 2.07 ± 0.72, P = 0.00066, 1.89 ± 0.52 vs 1.83 ± 0.53, P = 0.00031, respectively). CONCLUSIONS During non-stimulated left AVS, adrenal hormone secretion was slightly but significantly decreased after venography, similar to the normal time-related stress reaction. Venography did not increase the adrenal hormone secretion.
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Lim JS, Park S, Park SI, Oh YT, Choi E, Kim JY, Rhee Y. Cardiac Dysfunction in Association with Increased Inflammatory Markers in Primary Aldosteronism. Endocrinol Metab (Seoul) 2016; 31:567-576. [PMID: 27834080 PMCID: PMC5195834 DOI: 10.3803/enm.2016.31.4.567] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Revised: 08/29/2016] [Accepted: 09/08/2016] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Oxidative stress in primary aldosteronism (PA) is thought to worsen aldosterone-induced damage by activating proinflammatory processes. Therefore, we investigated whether inflammatory markers associated with oxidative stress is increased with negative impacts on heart function as evaluated by echocardiography in patients with PA. METHODS Thirty-two subjects (mean age, 50.3±11.0 years; 14 males, 18 females) whose aldosterone-renin ratio was more than 30 among patients who visited Severance Hospital since 2010 were enrolled. Interleukin-1β (IL-1β), IL-6, IL-8, monocyte chemoattractant protein 1, tumor necrosis factor α (TNF-α), and matrix metalloproteinase 2 (MMP-2), and MMP-9 were measured. All patients underwent adrenal venous sampling with complete access to both adrenal veins. RESULTS Only MMP-2 level was significantly higher in the aldosterone-producing adenoma (APA) group than in the bilateral adrenal hyperplasia (BAH). Patients with APA had significantly higher left ventricular (LV) mass and A velocity, compared to those with BAH. IL-1β was positively correlated with left atrial volume index. Both TNF-α and MMP-2 also had positive linear correlation with A velocity. Furthermore, MMP-9 showed a positive correlation with LV mass, whereas it was negatively correlated with LV end-systolic diameter. CONCLUSION These results suggest the possibility that some of inflammatory markers related to oxidative stress may be involved in developing diastolic dysfunction accompanied by LV hypertrophy in PA. Further investigations are needed to clarify the role of oxidative stress in the course of cardiac remodeling.
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Affiliation(s)
- Jung Soo Lim
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
- Institute of Evidence Based Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Sungha Park
- Division of Cardiology, Severance Cardiovascular Hospital and Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Sung Il Park
- Department of Radiology, Yonsei University College of Medicine, Seoul, Korea
| | - Young Taik Oh
- Department of Radiology, Yonsei University College of Medicine, Seoul, Korea
| | - Eunhee Choi
- Institute of Lifestyle Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Jang Young Kim
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Yumie Rhee
- Department of Internal Medicine, Severance Hospital, Endocrine Research Institute, Yonsei University College of Medicine, Seoul, Korea.
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Non-stimulated adrenal venous sampling using Dyna computed tomography in patients with primary aldosteronism. Sci Rep 2016; 6:37143. [PMID: 27876824 PMCID: PMC5120298 DOI: 10.1038/srep37143] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Accepted: 10/25/2016] [Indexed: 12/14/2022] Open
Abstract
In this retrospective study, we aimed to examine the effect of applying Dyna computed tomography (CT) on the success rate of adrenal venous sampling (AVS) without adrenocorticotropic hormone stimulation. A total of 100 consecutive patients with primary aldosteronism who underwent AVS between May 2012 and July 2015 were enrolled. In all the cases, Dyna CT was used in AVS to validate catheter position in the right adrenal vein. A selectivity index (cortisoladrenal vein /cortisolinferior vena cava) of ≥2.0 of both adrenal veins were required for successful AVS. Dyna CT indicated misplaced catheters in 16 patients; of these patients, 75% (12/16) eventually had successful right AVS after catheter repositioning. The success rate of initial sampling at the right adrenal vein was 76% (76/100), which increased to 88% (88/100) after Dyna CT was applied (p < 0.001). The most common inadvertently catheterised vessels detected using Dyna CT were the accessory hepatic veins (56.3%, 9/16), followed by the renal capsular veins (37.5%, 6/16). The overall success rate of non-stimulated AVS using Dyna CT was 87% (87/100). Thus, the application of Dyna CT further increased the success rate of non-stimulated AVS.
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Abstract
PURPOSE OF REVIEW Primary aldosteronism accounts for 3 to 5% of all hypertension cases. Unilateral aldosterone hypersecretion can be treated with adrenalectomy. Guidelines for primary aldosteronism management recommend adrenal vein sampling (AVS) to ascertain unilateral primary aldosteronism before surgery. Many different protocols are used to perform AVS and for the interpretation of its results, but without hard evidence of why one should be given preference. Experts have proposed recommendations to guide clinical practice and the grounds for future research to address this situation. RECENT FINDINGS Proper patient preparation is a prerequisite for interpretable results. New trends are emerging to improve adequate cannulation of adrenal veins including: training of a limited number of dedicated radiologists, contrast computed tomography of adrenal veins before or during AVS, and rapid assays to measure cortisol concentrations during AVS. Cosyntropin stimulation is performed in several centers to avoid the variability of cortisol secretion during AVS, but whether this improves diagnostic performance is unknown. SUMMARY Better markers of adequate catheter placement are currently under investigation, including other adrenal steroids and metanephrines. Innovative strategies for interpreting partially failed AVS are also being developed. Other approaches to ascertain primary aldosteronism subtype will be necessary because of limited patient access to AVS.
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Affiliation(s)
- Olivier Steichen
- aInternal Medicine Department, AP-HP, Tenon HospitalbFaculty of Medicine, Sorbonne Universités, UPMC University Paris 06cINSERM, Sorbonne Universités, UPMC Univ Paris 06, UMR_S1142dFaculty of Medicine, Université Paris-DescarteseHypertension Unit, AP-HP, Georges Pompidou European HospitalfINSERM, UMR_S970, équipe 14, Paris, France
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Doumas M, Douma S. Primary Aldosteronism: A Field on the Move. UPDATES IN HYPERTENSION AND CARDIOVASCULAR PROTECTION 2016. [DOI: 10.1007/978-3-319-34141-5_2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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