1
|
Yang F, Wang Y, Zhang Z, Zeng Y, Liu M, Tian Z, Li P. Effect of adrenocorticotropic hormone stimulation during adrenal vein sampling for the subtyping of primary aldosteronism: a prospective study. J Hypertens 2024; 42:1019-1026. [PMID: 38527056 DOI: 10.1097/hjh.0000000000003684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/27/2024]
Abstract
OBJECTIVE Adrenal venous sampling (AVS) is key for primary aldosteronism subtype identification. However, the value of adrenocorticotropic hormone (ACTH) stimulation in AVS is still controversial. METHODS In this prospective study, we investigated the role of continuous ACTH infusion on the performance and interpretation of bilateral simultaneous AVS using a standard protocol in 59 primary aldosteronism patients. We analyzed the selectivity index and lateralization index in AVS pre and post-ACTH and estimated the prognosis of patients who underwent adrenalectomy with different cutoff points of lateralization index post-ACTH. RESULTS The confirmed success rate of bilateral adrenal vein catheterization increased from 84% pre-ACTH to 95% post-ACTH. Fifty percent of the patients had a decline in lateralization index post-ACTH, 30% of patients showed unilateral primary aldosteronism pre-ACTH but bilateral primary aldosteronism post-ACTH according to lateralization index at least 2 pre-ACTH and lateralization index at least 4 post-ACTH. The outcomes of the patients with primary aldosteronism after adrenalectomy indicated that all patients achieved clinical and biochemical success regardless of lateralization index at least 4 or less than 4 post-ACTH. Receiver operating characteristic curves showed that lateralization index cutoff 2.58 post-ACTH stimulation yielded the best threshold in lateralization with a sensitivity of 73.1% and a specificity of 92.9%. CONCLUSION ACTH stimulation increased the AVS success rates in patients with primary aldosteronism, reduced lateralization index in some cases and decreased the proportion of identified unilateral primary aldosteronism, resulting in some patients losing the opportunity for disease cure. Compared with lateralization index at least 4, a lower cutoff point of lateralization index at least 2.58 after ACTH stimulation has better accuracy of lateralization diagnosis.
Collapse
Affiliation(s)
- Fan Yang
- Department of Endocrinology, Endocrine and Metabolic Disease Medical Center, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
- Department of Endocrinology, Endocrine and Metabolic Disease Medical Center, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, China
- Branch of National Clinical Research Center for Metabolic Diseases, Nanjing, China
| | - Yijie Wang
- Department of Endocrinology, Endocrine and Metabolic Disease Medical Center, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
- Department of Endocrinology, Endocrine and Metabolic Disease Medical Center, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, China
- Branch of National Clinical Research Center for Metabolic Diseases, Nanjing, China
| | - Ziwei Zhang
- Department of Endocrinology, Endocrine and Metabolic Disease Medical Center, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
- Department of Endocrinology, Endocrine and Metabolic Disease Medical Center, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, China
- Branch of National Clinical Research Center for Metabolic Diseases, Nanjing, China
| | - Yangjie Zeng
- Department of Endocrinology, Endocrine and Metabolic Disease Medical Center, Nanjing Drum Tower Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Nanjing, China
- Branch of National Clinical Research Center for Metabolic Diseases, Nanjing, China
| | - Mengsi Liu
- Department of Endocrinology, Endocrine and Metabolic Disease Medical Center, Nanjing Drum Tower Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Nanjing, China
- Branch of National Clinical Research Center for Metabolic Diseases, Nanjing, China
| | - Zhaoyang Tian
- Department of Endocrinology, Endocrine and Metabolic Disease Medical Center, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
- Branch of National Clinical Research Center for Metabolic Diseases, Nanjing, China
| | - Ping Li
- Department of Endocrinology, Endocrine and Metabolic Disease Medical Center, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
- Department of Endocrinology, Endocrine and Metabolic Disease Medical Center, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, China
- Branch of National Clinical Research Center for Metabolic Diseases, Nanjing, China
| |
Collapse
|
2
|
Liu J, Shao S, Wang Q, Zhang Z, Ding X, Zhao L, Wang J, Ji X, Dai Q, Du M, Zhang Z. Antecubital vein combined with femoral vein pathway could shorten the learning curve of simultaneous bilateral adrenal vein sampling. J Clin Hypertens (Greenwich) 2024; 26:635-644. [PMID: 38751037 PMCID: PMC11180688 DOI: 10.1111/jch.14828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 04/05/2024] [Accepted: 04/12/2024] [Indexed: 06/18/2024]
Abstract
During our previous bilateral adrenal vein sampling (AVS) procedure, the authors observed that accessing the left adrenal vein through the antecubital vein was more feasible than the conventional femoral vein. Meanwhile, the femoral vein pathway facilitated access to the right adrenal vein than the antecubital vein pathway. Therefore, the authors hypothesized that simultaneous bilateral AVS via the antecubital combined with the femoral vein pathway could improve the success rate. A total of 94 cases of AVS via the antecubital combined with the femoral vein pathway were performed, while the remaining 20 cases employed the antecubital vein pathway at our center between August 2020 and April 2023. Furthermore, a meta-analysis was conducted in this study using 15 selected articles to determine the success rate of AVS in each center and pathway. The success rate of ACTH-stimulated simultaneous bilateral AVS via the antecubital vein combined with the femoral vein pathway was 92.85% (P = .503) on the right and 95.00% (P < .001) on the left. In the antecubital vein pathway, the success rates were only 25.00% (P < .001) on the right side and 80.00% (P = .289) on the left side. The results of meta-analysis demonstrated a success rate of 78.16% on the right and 94.98% on the left for ACTH-stimulated AVS via the femoral vein pathway. Based on our center's experience, simultaneous bilateral adrenal vein sampling via the combined pathway could improve the success rate of AVS in the short term and shorten the learning curve.
Collapse
Affiliation(s)
- Jiaqi Liu
- Department of CardiologyShanghai General Hospital (originally named Shanghai First People’s Hospital), Shanghai Jiaotong University School of medicineShanghaiChina
| | - Shuai Shao
- Department of CardiologyShanghai General Hospital (originally named Shanghai First People’s Hospital), Shanghai Jiaotong University School of medicineShanghaiChina
| | - Qiuli Wang
- Department of NursingShanghai General Hospital (originally named Shanghai First People’s Hospital), Shanghai Jiaotong University School of medicineShanghaiChina
| | - Zhiping Zhang
- Department of CardiologyShanghai General Hospital (originally named Shanghai First People’s Hospital), Shanghai Jiaotong University School of medicineShanghaiChina
| | - Xiaoying Ding
- Department of EndocrinologyShanghai General Hospital (originally named Shanghai First People’s Hospital), Shanghai Jiaotong University School of medicineShanghaiChina
| | - Li Zhao
- Department of EndocrinologyShanghai General Hospital (originally named Shanghai First People’s Hospital), Shanghai Jiaotong University School of medicineShanghaiChina
| | - Jinliang Wang
- School of Health Science and EngineeringUniversity of Shanghai for Science and TechnologyShanghaiChina
| | - Xiaohong Ji
- Department of NursingShanghai General Hospital (originally named Shanghai First People’s Hospital), Shanghai Jiaotong University School of medicineShanghaiChina
| | - Qiuyan Dai
- Department of CardiologyShanghai General Hospital (originally named Shanghai First People’s Hospital), Shanghai Jiaotong University School of medicineShanghaiChina
| | - Mingli Du
- Department of NursingShanghai General Hospital (originally named Shanghai First People’s Hospital), Shanghai Jiaotong University School of medicineShanghaiChina
| | - Zhi Zhang
- Department of CardiologyShanghai General Hospital (originally named Shanghai First People’s Hospital), Shanghai Jiaotong University School of medicineShanghaiChina
| |
Collapse
|
3
|
Ng E, Chong W, Lau KK, Gwini SM, Carroll RW, Doery JC, Fuller PJ, Yang J. The where, who and how of adrenal vein sampling in Australia and New Zealand. J Med Imaging Radiat Oncol 2024; 68:87-93. [PMID: 37694592 DOI: 10.1111/1754-9485.13573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 08/11/2023] [Indexed: 09/12/2023]
Abstract
INTRODUCTION Primary aldosteronism (PA) causes 10-15% of cases of hypertension, and it is increasingly recognised as being under-diagnosed. An interventional radiology procedure, adrenal vein sampling (AVS), is a necessary and important diagnostic procedure for complete workup of PA. There is an anticipated increase in demand for AVS as detection of PA improves. This study aims to describe the current landscape of AVS in Australia and New Zealand (NZ). METHODS Two surveys exploring AVS methodology and performance were conducted of (i) Endocrinology Unit Heads and (ii) interventional radiologists who perform AVS, at public hospitals with Endocrinology Units across Australia and NZ. RESULTS Responses were received from 48/53 Endocrinology Unit Heads (91%) and 35 radiologists from 26 sites (87% of AVS sites). AVS was provided at 28/48 Endocrinology sites (58%) across Australia and NZ. In Australia, sites were concentrated in Victoria, New South Wales and Queensland with none in the Northern Territory; in NZ, sites were more evenly distributed across the North and South Islands. AVS was performed by 1-2 dedicated radiologists at 24 sites, 2-3 radiologists at two sites and a rotating roster of radiologists at two sites. Responses to both surveys revealed significant variation in AVS methodology and interpretation of AVS results. CONCLUSION There is significant heterogeneity in the availability of AVS, the procedural details and the interpretation of results across Australia and NZ, which potentially impacts the quality of patient care and ability to scale up AVS capacity to meet increasing demand.
Collapse
Affiliation(s)
- Elisabeth Ng
- Centre for Endocrinology & Metabolism, Hudson Institute of Medical Research, Victoria, Melbourne, Australia
- Department of Endocrinology, Monash Health, Victoria, Melbourne, Australia
| | - Winston Chong
- Department of Diagnostic Imaging, Monash Health, Melbourne, Victoria, Australia
| | - Kenneth K Lau
- Department of Diagnostic Imaging, Monash Health, Melbourne, Victoria, Australia
| | - Stella May Gwini
- School of Public Health and Preventive Medicine, Monash University, Victoria, Melbourne, Australia
| | - Richard W Carroll
- Department of Endocrinology, Wellington Regional Hospital, Wellington, New Zealand
| | - James Cg Doery
- Department of Chemical Pathology, Monash Health, Victoria, Melbourne, Australia
- Department of Medicine, Monash University, Victoria, Melbourne, Australia
| | - Peter J Fuller
- Centre for Endocrinology & Metabolism, Hudson Institute of Medical Research, Victoria, Melbourne, Australia
- Department of Endocrinology, Monash Health, Victoria, Melbourne, Australia
| | - Jun Yang
- Centre for Endocrinology & Metabolism, Hudson Institute of Medical Research, Victoria, Melbourne, Australia
- Department of Endocrinology, Monash Health, Victoria, Melbourne, Australia
- Department of Medicine, Monash University, Victoria, Melbourne, Australia
| |
Collapse
|
4
|
Ng E, Gwini SM, Zheng W, Fuller PJ, Yang J. Predicting Bilateral Subtypes of Primary Aldosteronism Without Adrenal Vein Sampling: A Systematic Review and Meta-analysis. J Clin Endocrinol Metab 2024; 109:e837-e855. [PMID: 37531636 DOI: 10.1210/clinem/dgad451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 06/19/2023] [Accepted: 07/31/2023] [Indexed: 08/04/2023]
Abstract
CONTEXT Primary aldosteronism (PA) is the most common endocrine cause of hypertension. The final diagnostic step involves subtyping, using adrenal vein sampling (AVS), to determine if PA is unilateral or bilateral. The complete PA diagnostic process is time and resource intensive, which can impact rates of diagnosis and treatment. Previous studies have developed tools to predict bilateral PA before AVS. OBJECTIVE Evaluate the sensitivity and specificity of published tools that aim to identify bilateral subtypes of PA. METHODS Medline and Embase databases were searched to identify published models that sought to subtype PA, and algorithms to predict bilateral PA are reported. Meta-analysis and meta-regression were then performed. RESULTS There were 35 studies included, evaluating 55 unique algorithms to predict bilateral PA. The algorithms were grouped into 6 categories: those combining biochemical, radiological, and demographic characteristics (A); confirmatory testing alone or combined with biochemical, radiological, and demographic characteristics (B); biochemistry results alone (C); adrenocorticotropic hormone stimulation testing (D); anatomical imaging (E); and functional imaging (F). Across the identified algorithms, sensitivity and specificity ranged from 5% to 100% and 36% to 100%, respectively. Meta-analysis of 30 unique predictive tools from 32 studies showed that the group A algorithms had the highest specificity for predicting bilateral PA, while group F had the highest sensitivity. CONCLUSIONS Despite the variability in published predictive algorithms, they are likely important for decision-making regarding the value of AVS. Prospective validation may enable medical treatment upfront for people with a high likelihood of bilateral PA without the need for an invasive and resource-intensive test.
Collapse
Affiliation(s)
- Elisabeth Ng
- Centre for Endocrinology & Metabolism, Hudson Institute of Medical Research, Clayton, Australia
- Department of Endocrinology, Monash Health, Clayton, Australia
- Department of Molecular and Translational Science, Monash University, Clayton, Australia
| | - Stella May Gwini
- Centre for Endocrinology & Metabolism, Hudson Institute of Medical Research, Clayton, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Winston Zheng
- Department of Endocrinology, Monash Health, Clayton, Australia
| | - Peter J Fuller
- Centre for Endocrinology & Metabolism, Hudson Institute of Medical Research, Clayton, Australia
- Department of Endocrinology, Monash Health, Clayton, Australia
- Department of Molecular and Translational Science, Monash University, Clayton, Australia
| | - Jun Yang
- Centre for Endocrinology & Metabolism, Hudson Institute of Medical Research, Clayton, Australia
- Department of Endocrinology, Monash Health, Clayton, Australia
- Department of Molecular and Translational Science, Monash University, Clayton, Australia
- Department of Medicine, Monash University, Clayton, Australia
| |
Collapse
|
5
|
Younes N, Larose S, Bourdeau I, Therasse E, Lacroix A. Role of Adrenal Vein Sampling in Guiding Surgical Decision in Primary Aldosteronism. Exp Clin Endocrinol Diabetes 2023; 131:418-434. [PMID: 37567230 DOI: 10.1055/a-2106-4663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/13/2023]
Abstract
Adrenal vein sampling (AVS) is recommended for subtyping primary aldosteronism (PA) to identify lateralized or bilateral sources of aldosterone excess, allowing for better decision-making in regard to medical or surgical management on a case-by-case basis. To date, no consensus exists on protocols to be used during AVS, especially concerning sampling techniques, the timing of sampling, and whether or not to use adrenocorticotropic hormone (ACTH) stimulation. Interpretation criteria for selectivity, lateralization, and contralateral suppression vary from one expert center to another, with some favoring strict cut-offs to others being more permissive. Clinical and biochemical post-operative outcomes can also be influenced by AVS criteria utilized to indicate surgical therapy.In this review, we reanalyze studies on AVS highlighting the recent pathological findings of frequent micronodular hyperplasia adjacent to a dominant aldosteronoma (APA) overlapping with bilateral idiopathic hyperaldosteronism (IHA) etiologies, as opposed to the less frequent unilateral single aldosteronoma. The variable expression of melanocortin type 2 receptors in the nodules and hyperplasia may explain the frequent discordance in lateralization ratios between unstimulated and ACTH- stimulated samples. We conclude that aldosterone values collected during simultaneous bilateral sampling, both at baseline and post-ACTH stimulation, are required to adequately evaluate selectivity, lateralization, and contralateral suppression during AVS, to better identify all patients with PA that can benefit from a surgical indication. Recommended cut-offs for each ratio are also presented.
Collapse
Affiliation(s)
- Nada Younes
- Division of Endocrinology, Department of Medicine and Research Center, Centre hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada
| | - Stéphanie Larose
- Division of Endocrinology, Department of Medicine and Research Center, Centre hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada
| | - Isabelle Bourdeau
- Division of Endocrinology, Department of Medicine and Research Center, Centre hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada
| | - Eric Therasse
- Department of Radiology, Centre de Recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), Université de Montréal, Québec, Canada
| | - André Lacroix
- Division of Endocrinology, Department of Medicine and Research Center, Centre hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada
| |
Collapse
|
6
|
Zibar Tomsic K, Dusek T, Alduk A, Knezevic N, Molnar V, Kraljevic I, Skoric Polovina T, Balasko A, Solak M, Matas N, Popovac H, Kralik-Oguic S, Kastelan D. Subtyping primary aldosteronism by inconclusive adrenal vein sampling: A derivation and validation study in a tertiary centre. Clin Endocrinol (Oxf) 2022; 97:849-859. [PMID: 35781892 DOI: 10.1111/cen.14794] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 06/17/2022] [Accepted: 06/30/2022] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Indices based on aldosterone/cortisol (A/C) concentration in the successfully cannulated adrenal vein (AV) and in the inferior vena cava (IVC) (AV/IVC) appear to be possible markers to verify the subtype of primary aldosteronism (PA) in the case of inconclusive results of adrenal vein sampling (AVS). The variability of results in previous studies encouraged us to calculate AV/IVC and adrenal A/C cutoff values that could predict the aetiology of PA. METHODS This retrospective study included 96 patients who underwent AVS due to PA between 2015 and 2020. The derivation cohort ultimately consisted of 60 patients with bilaterally successful AVS and a clear diagnosis of unilateral or bilateral disease. Receiver operating characteristic analysis was used to find the optimal A/C and AV/IVC cutoff values predicting the subtype of PA. The validation cohort consisted of 11 patients with either unsuccessful cannulation or a borderline lateralization index (LI), those patients underwent adrenalectomy because their indices were suggestive of unilateral disease based on the derivation cohort data. RESULTS The cutoff values of A/C ≤ 0.63 or AV/IVC ≤ 0.37 identified unaffected glands with a sensitivity of 91.2% and 97.1%, respectively, and a specificity of 90.7% and 88.4%, respectively. Unilateral ipsilateral gland involvement was characterized by A/C ≥ 3.5 or AV/IVC ≥ 3.4 with a corresponding specificity of 100%. All patients in the validation cohort achieved biochemical remission postoperatively. CONCLUSIONS A/C and AV/IVC cutoff values could be a useful tool to determine the subtype of PA in patients with unilateral successful AVS as well as in patients with a borderline LI.
Collapse
Affiliation(s)
- Karin Zibar Tomsic
- Department of Endocrinology, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Tina Dusek
- Department of Endocrinology, University Hospital Centre Zagreb, Zagreb, Croatia
- School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Anamarija Alduk
- School of Medicine, University of Zagreb, Zagreb, Croatia
- Department of Radiology, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Nikola Knezevic
- School of Medicine, University of Zagreb, Zagreb, Croatia
- Department of Urology, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Vilim Molnar
- St. Catherine Specialty Hospital, Zagreb, Croatia
| | - Ivana Kraljevic
- Department of Endocrinology, University Hospital Centre Zagreb, Zagreb, Croatia
- School of Medicine, University of Zagreb, Zagreb, Croatia
| | | | - Annemarie Balasko
- Department of Endocrinology, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Mirsala Solak
- Department of Endocrinology, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Nino Matas
- Department of Internal Medicine, General Hospital Dubrovnik, Dubrovnik, Croatia
| | - Hrvoje Popovac
- Department of Endocrinology, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Sasa Kralik-Oguic
- School of Medicine, University of Zagreb, Zagreb, Croatia
- Department of Laboratory Diagnostics, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Darko Kastelan
- Department of Endocrinology, University Hospital Centre Zagreb, Zagreb, Croatia
- School of Medicine, University of Zagreb, Zagreb, Croatia
| |
Collapse
|
7
|
Zhang J, Yang J, Libianto R, Shen J, Fuller PJ, Grodski S, Lee JC. Impact of dedicated multidisciplinary service on patient selection and outcomes for surgical treatment of primary aldosteronism. Surgery 2022; 172:1682-1688. [PMID: 36123178 DOI: 10.1016/j.surg.2022.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 05/22/2022] [Accepted: 08/04/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Primary aldosteronism is the most common surgically curable cause of endocrine hypertension. Management of the unilateral subtype of primary aldosteronism with adrenalectomy requires multidisciplinary input. It is unclear if a dedicated endocrine hypertension service confers better outcomes compared to standard care offered by individual clinicians. METHODS In this retrospective study, patients from the Monash University Endocrine Surgery Database were divided into either the endocrine hypertension service group, where patients were managed by a dedicated multidisciplinary team, or the standard group, where patients were managed by individual clinicians. The comparisons included patient selection for surgery, perioperative blood pressure control, and surgical cure rate. RESULTS Despite similar perioperative blood pressure, patients in the endocrine hypertension service group (n = 41) were on fewer antihypertensive medications (1 vs 2, P = .011) compared to the standard group (n = 55). A larger proportion of patients in the endocrine hypertension service group had either bilateral adrenal nodules or no adrenal lesions on computed tomography (41% vs 18%, P = .013). Patients in the standard group had larger adrenal lesions on computed tomography (median 15 mm vs 10 mm, P = .032). Postoperatively, the biochemical cure rate was higher in the endocrine hypertension service group at 6 to 12 months (97% vs 76%, P = .021). CONCLUSION Patients managed by endocrine hypertension service were more likely to be diagnosed with surgically curable primary aldosteronism without a unilateral adrenal adenoma on imaging, required fewer medications for perioperative blood pressure control, and experienced superior postoperative outcomes. Referral to a dedicated endocrine hypertension service is recommended for patients with primary aldosteronism who wish to pursue a surgical cure.
Collapse
Affiliation(s)
- Jinghong Zhang
- Department of Endocrinology, Monash Health, Victoria, Australia. https://twitter.com/zhang_jinghong
| | - Jun Yang
- Department of Endocrinology, Monash Health, Victoria, Australia; Department of Medicine, Monash University, Victoria, Australia; Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Victoria, Australia. https://twitter.com/drlouisesegan
| | - Renata Libianto
- Department of Endocrinology, Monash Health, Victoria, Australia; Department of Medicine, Monash University, Victoria, Australia; Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Victoria, Australia
| | - Jimmy Shen
- Department of Endocrinology, Monash Health, Victoria, Australia; Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Victoria, Australia
| | - Peter J Fuller
- Department of Endocrinology, Monash Health, Victoria, Australia; Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Victoria, Australia
| | - Simon Grodski
- Monash University Endocrine Surgery Unit, Monash University, Victoria, Australia; Department of Surgery, Monash Health, Victoria, Australia; Department of Surgery, Central Clinical School, Monash University, Victoria, Australia
| | - James C Lee
- Monash University Endocrine Surgery Unit, Monash University, Victoria, Australia; Department of Surgery, Monash Health, Victoria, Australia; Department of Surgery, Central Clinical School, Monash University, Victoria, Australia.
| |
Collapse
|
8
|
Abstract
Primary aldosteronism is a common cause of hypertension and is a risk factor for cardiovascular and renal morbidity and mortality, via mechanisms mediated by both hypertension and direct insults to target organs. Despite its high prevalence and associated complications, primary aldosteronism remains largely under-recognized, with less than 2% of people in at-risk populations ever tested. Fundamental progress made over the past decade has transformed our understanding of the pathogenesis of primary aldosteronism and of its clinical phenotypes. The dichotomous paradigm of primary aldosteronism diagnosis and subtyping is being redefined into a multidimensional spectrum of disease, which spans subclinical stages to florid primary aldosteronism, and from single-focal or multifocal to diffuse aldosterone-producing areas, which can affect one or both adrenal glands. This Review discusses how redefining the primary aldosteronism syndrome as a multidimensional spectrum will affect the approach to the diagnosis and subtyping of primary aldosteronism.
Collapse
Affiliation(s)
- Adina F Turcu
- Division of Metabolism, Endocrinology, and Diabetes, University of Michigan, Ann Arbor, MI, USA.
| | - Jun Yang
- Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Clayton, Victoria, Australia
- Department of Medicine, Monash University, Clayton, Victoria, Australia
| | - Anand Vaidya
- Center for Adrenal Disorders, Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
9
|
Yang J, Libianto R, Lau KK, Doery JCG, Wan KL, Chee NYN, Shen J, Fuller PJ, Chong W. Impact of Intraprocedural Sedation on Adrenal Vein Sampling without Corticotropin Stimulation. Radiology 2022; 304:716-718. [PMID: 35608441 DOI: 10.1148/radiol.212627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
See also the editorial by Georgiades in this issue.
Collapse
Affiliation(s)
- Jun Yang
- From the Department of Endocrinology (J.Y., R.L., N.Y.N.C., J.S., P.J.F.), Monash Imaging (K.K.L., W.C.), and Monash Pathology (J.C.G.D., K.L.W.), Monash Health, Clayton, Australia; Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, 27-31 Wright St, Clayton, VIC 3168, Australia (J.Y., R.L., J.S., P.J.F.); and School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Australia (J.Y., K.K.L., J.C.G.D.)
| | - Renata Libianto
- From the Department of Endocrinology (J.Y., R.L., N.Y.N.C., J.S., P.J.F.), Monash Imaging (K.K.L., W.C.), and Monash Pathology (J.C.G.D., K.L.W.), Monash Health, Clayton, Australia; Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, 27-31 Wright St, Clayton, VIC 3168, Australia (J.Y., R.L., J.S., P.J.F.); and School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Australia (J.Y., K.K.L., J.C.G.D.)
| | - Kenneth K Lau
- From the Department of Endocrinology (J.Y., R.L., N.Y.N.C., J.S., P.J.F.), Monash Imaging (K.K.L., W.C.), and Monash Pathology (J.C.G.D., K.L.W.), Monash Health, Clayton, Australia; Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, 27-31 Wright St, Clayton, VIC 3168, Australia (J.Y., R.L., J.S., P.J.F.); and School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Australia (J.Y., K.K.L., J.C.G.D.)
| | - James C G Doery
- From the Department of Endocrinology (J.Y., R.L., N.Y.N.C., J.S., P.J.F.), Monash Imaging (K.K.L., W.C.), and Monash Pathology (J.C.G.D., K.L.W.), Monash Health, Clayton, Australia; Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, 27-31 Wright St, Clayton, VIC 3168, Australia (J.Y., R.L., J.S., P.J.F.); and School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Australia (J.Y., K.K.L., J.C.G.D.)
| | - Ken L Wan
- From the Department of Endocrinology (J.Y., R.L., N.Y.N.C., J.S., P.J.F.), Monash Imaging (K.K.L., W.C.), and Monash Pathology (J.C.G.D., K.L.W.), Monash Health, Clayton, Australia; Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, 27-31 Wright St, Clayton, VIC 3168, Australia (J.Y., R.L., J.S., P.J.F.); and School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Australia (J.Y., K.K.L., J.C.G.D.)
| | - Nicholas Y N Chee
- From the Department of Endocrinology (J.Y., R.L., N.Y.N.C., J.S., P.J.F.), Monash Imaging (K.K.L., W.C.), and Monash Pathology (J.C.G.D., K.L.W.), Monash Health, Clayton, Australia; Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, 27-31 Wright St, Clayton, VIC 3168, Australia (J.Y., R.L., J.S., P.J.F.); and School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Australia (J.Y., K.K.L., J.C.G.D.)
| | - Jimmy Shen
- From the Department of Endocrinology (J.Y., R.L., N.Y.N.C., J.S., P.J.F.), Monash Imaging (K.K.L., W.C.), and Monash Pathology (J.C.G.D., K.L.W.), Monash Health, Clayton, Australia; Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, 27-31 Wright St, Clayton, VIC 3168, Australia (J.Y., R.L., J.S., P.J.F.); and School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Australia (J.Y., K.K.L., J.C.G.D.)
| | - Peter J Fuller
- From the Department of Endocrinology (J.Y., R.L., N.Y.N.C., J.S., P.J.F.), Monash Imaging (K.K.L., W.C.), and Monash Pathology (J.C.G.D., K.L.W.), Monash Health, Clayton, Australia; Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, 27-31 Wright St, Clayton, VIC 3168, Australia (J.Y., R.L., J.S., P.J.F.); and School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Australia (J.Y., K.K.L., J.C.G.D.)
| | - Winston Chong
- From the Department of Endocrinology (J.Y., R.L., N.Y.N.C., J.S., P.J.F.), Monash Imaging (K.K.L., W.C.), and Monash Pathology (J.C.G.D., K.L.W.), Monash Health, Clayton, Australia; Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, 27-31 Wright St, Clayton, VIC 3168, Australia (J.Y., R.L., J.S., P.J.F.); and School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Australia (J.Y., K.K.L., J.C.G.D.)
| |
Collapse
|
10
|
Libianto R, Russell GM, Stowasser M, Gwini SM, Nuttall P, Shen J, Young MJ, Fuller PJ, Yang J. Detecting primary aldosteronism in Australian primary care: a prospective study. Med J Aust 2022; 216:408-412. [PMID: 35218017 DOI: 10.5694/mja2.51438] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 09/03/2021] [Accepted: 09/10/2021] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To assess the identification of primary aldosteronism (PA) in newly diagnosed, treatment-naïve patients with hypertension by screening in primary care. DESIGN Prospective study. SETTING General practices in the South Eastern Melbourne Primary Health Network with at least three general practitioners and general practices elsewhere in Victoria that had referred patients to the Endocrine Hypertension Clinic at Monash Health, 2017-2020. PARTICIPANTS Adults (18-80 years) with newly diagnosed hypertension (measurements of systolic blood pressure > 140 mmHg or diastolic blood pressure > 90 mmHg on at least two occasions) and not taking antihypertensive medications were screened for PA by assessing their aldosterone-to-renin ratio (ARR). Participants with two ARR values exceeding 70 pmol/mU underwent saline suppression testing at the Endocrine Hypertension Service (Monash Health) to confirm the diagnosis of PA. MAIN OUTCOME MEASURES Prevalence of PA (number of patients with confirmed PA divided by number screened). RESULTS Sixty-two of 247 screened participants had elevated ARR values on screening (25%); for 35 people (14%; 95% CI, 10-19%), PA was confirmed by saline suppression testing. Baseline characteristics (mean age, sex distribution, median baseline blood pressure levels, and serum potassium concentration) were similar for people with or without PA. CONCLUSION PA was diagnosed in 14% of patients with newly diagnosed hypertension screened by GPs, indicating a potential role for GPs in the early detection of an important form of secondary hypertension for which specific therapies are available.
Collapse
Affiliation(s)
- Renata Libianto
- Monash Health, Melbourne, VIC.,Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Melbourne, VIC
| | | | - Michael Stowasser
- Endocrine Hypertension Research Centre, University of Queensland, Brisbane, QLD
| | | | - Peta Nuttall
- Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Melbourne, VIC
| | - Jimmy Shen
- Monash Health, Melbourne, VIC.,Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Melbourne, VIC
| | - Morag J Young
- Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Melbourne, VIC
| | - Peter J Fuller
- Monash Health, Melbourne, VIC.,Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Melbourne, VIC
| | - Jun Yang
- Monash Health, Melbourne, VIC.,Monash University, Melbourne, VIC
| |
Collapse
|
11
|
Ma Y, Chen H, Chen F, Jiang J, Guo W, Li X, Gao X, Lu Z, Zhou B, Zhao L, Li X. Mass spectrometry-based cortisol profiling during adrenal venous sampling reveals misdiagnosis for subtyping primary aldosteronism. Clin Endocrinol (Oxf) 2022; 96:680-689. [PMID: 34970750 DOI: 10.1111/cen.14666] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 12/16/2021] [Accepted: 12/18/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Primary aldosteronism (PA) is a common form of secondary hypertension. Adrenal venous sampling (AVS) is the gold standard for subtyping PA. This study aimed to determine whether there is a difference between immunoassays and liquid chromatography-mass spectrometry (LC-MS/MS) methods for measuring cortisol levels that affect the judgement of AVS. DESIGN This was a retrospective study. PATIENTS Included 72 patients who were diagnosed with PA and had undergone AVS. MEASUREMENTS Patients were grouped according to whether they received adrenocorticotropic hormone (ACTH) stimulation during AVS, and the cortisol results were measured using immunoassay and LC-MS/MS. RESULTS There were 48 patients in the without ACTH stimulation group and 24 in the post-ACTH stimulation group during AVS (bilateral adrenal vein cannulation success rate, 56.25% vs. 83.33%). ACTH stimulation was beneficial for increasing the success rate of AVS (p < .001). Immunoassays were linearly correlated with LC-MS/MS when cortisol concentrations were <1750 nmol/L (r = .959, p < .001). When cortisol concentrations were >17,500 nmol/L, no correlation was found between the two methods (p = .093). The two methods were consistent for the detection of cortisol for evaluating the success of cannulation for AVS. Five percent of patients showed discordant lateralization of aldosterone production according to the cortisol LC-MS/MS and immunoassay results in the without ACTH group, and 15% showed discordant lateralization in the post-ACTH group. CONCLUSIONS The immunoassay method can be used to determine whether cannulation is successful. The final decision for lateralization may be more appropriate based on LC-MS/MS results.
Collapse
Affiliation(s)
- Ying Ma
- Department of Endocrinology and Metabolism, Fudan Institute of Metabolic Diseases, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Hong Chen
- Department of Endocrinology and Metabolism, Fudan Institute of Metabolic Diseases, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Fangjun Chen
- Department of Laboratory Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jingjing Jiang
- Department of Endocrinology and Metabolism, Fudan Institute of Metabolic Diseases, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Wei Guo
- Department of Laboratory Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xiaoying Li
- Department of Endocrinology and Metabolism, Fudan Institute of Metabolic Diseases, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xin Gao
- Department of Endocrinology and Metabolism, Fudan Institute of Metabolic Diseases, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Zhiqiang Lu
- Department of Endocrinology and Metabolism, Fudan Institute of Metabolic Diseases, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Bo Zhou
- Department of Interventional Radiology, National Clinical Research Center for Interventional Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Lin Zhao
- Department of Endocrinology and Metabolism, Fudan Institute of Metabolic Diseases, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xiaomu Li
- Department of Endocrinology and Metabolism, Fudan Institute of Metabolic Diseases, Zhongshan Hospital, Fudan University, Shanghai, China
| |
Collapse
|
12
|
Zhang J, Libianto R, Lee JC, Grodski S, Shen J, Fuller PJ, Yang J. Preoperative mineralocorticoid receptor antagonist reduces postoperative hyperkalaemia in patients with Conn syndrome. Clin Endocrinol (Oxf) 2022; 96:40-46. [PMID: 34743353 DOI: 10.1111/cen.14630] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 10/21/2021] [Accepted: 10/25/2021] [Indexed: 01/23/2023]
Abstract
BACKGROUND The preoperative use of mineralocorticoid receptor antagonists (MRA) in patients with unilateral forms of primary aldosteronism (PA) is not standardized. The current Endocrine Society Guidelines do not specifically recommend MRA treatment before surgery. It is unclear whether preoperative MRA can optimize perioperative blood pressure and potassium control, and reduce the incidence of postoperative hyperkalaemia. OBJECTIVE This study aimed to investigate the effect of MRA on the incidence of postoperative hyperkalaemia in addition to perioperative blood pressure and potassium concentration in patients undergoing unilateral adrenalectomy for the treatment of PA. DESIGN Retrospective cohort study. SETTING Tertiary referral centres, Victoria, Australia. PATIENTS A total of 96 patients who were diagnosed with unilateral forms of PA: 73 patients ('MRA' group) received preoperative MRA while 23 patients ('No-MRA' group) did not. RESULTS The prevalence of postoperative hyperkalaemia was significantly higher in the 'No-MRA' group at 2-4 weeks after surgery, compared to the 'MRA' group (35% vs. 11%, p = .014). In a logistic regression, the use of MRA significantly predicted a lower incidence of postoperative hyperkalaemia after adjusting for age, sex, baseline aldosterone-to-renin ratio, potassium and preoperative eGFR. Before surgery, patients in the 'MRA' group had normalized blood pressure and potassium concentration requiring fewer antihypertensive medications and no potassium supplements. CONCLUSION Preoperative MRA use was associated with optimal perioperative blood pressure and normalized serum potassium in addition to a lower incidence of postoperative hyperkalaemia. MRA should be considered standard treatment for patients awaiting surgery for PA.
Collapse
Affiliation(s)
- Jinghong Zhang
- Central Clinical School, Monash University, Clayton, Victoria, Australia
| | - Renata Libianto
- Department of Endocrinology, Monash Health, Clayton, Victoria, Australia
- Department of Medicine, Monash University, Clayton, Victoria, Australia
- Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Clayton, Victoria, Australia
| | - James C Lee
- Monash University Endocrine Surgery Unit, Alfred Hospital, Melbourne, Victoria, Australia
- Department of Surgery, Monash University, Melbourne, Victoria, Australia
- Department of Surgery, Monash Health, Clayton, Victoria, Australia
| | - Simon Grodski
- Monash University Endocrine Surgery Unit, Alfred Hospital, Melbourne, Victoria, Australia
- Department of Surgery, Monash University, Melbourne, Victoria, Australia
- Department of Surgery, Monash Health, Clayton, Victoria, Australia
| | - Jimmy Shen
- Department of Endocrinology, Monash Health, Clayton, Victoria, Australia
- Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Clayton, Victoria, Australia
| | - Peter J Fuller
- Department of Endocrinology, Monash Health, Clayton, Victoria, Australia
- Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Clayton, Victoria, Australia
| | - Jun Yang
- Department of Endocrinology, Monash Health, Clayton, Victoria, Australia
- Department of Medicine, Monash University, Clayton, Victoria, Australia
- Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Clayton, Victoria, Australia
| |
Collapse
|
13
|
Yang J, Yu Y, Zhang Z, Wu Y, He Z. Adrenal venous sampling with adrenocorticotropic hormone stimulation: A meta-analysis. Int J Clin Pract 2021; 75:e14438. [PMID: 34096147 DOI: 10.1111/ijcp.14438] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 04/24/2021] [Accepted: 06/03/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND This meta-analysis was performed to compare the effect of adrenal venous sampling with adrenocorticotropic hormone with that without adrenocorticotropic hormone in subjects with primary aldosteronism. METHODS A systematic literature search up to May 2020 was performed and 17 studies were detected with 1878 subjects who had adrenal venous sampling operations. They reported relationships between with and without adrenocorticotropic hormone stimulation during adrenal venous sampling in subjects with primary aldosteronism. We calculated the odds ratio (OR) with 95% confidence intervals (CIs), using the dichotomous method with a random- or fixed-effect model. RESULTS Adrenal venous sampling operations with adrenocorticotropic hormone stimulation had statistically significant lower incorrect lateralisation (OR, 0.57; 95% CI, 0.43-0.75, P < .001); lower unsuccessful cannulations in both adrenal veins (OR, 0.35; 95% CI, 0.21-0.58, P < .001); lower unsuccessful cannulations of left adrenal vein (OR, 0.10; 95% CI, 0.06-0.17, P < .001) and lower unsuccessful cannulations of right adrenal vein (OR, 0.25; 95% CI, 0.11-0.54, P < .001) compared with without adrenocorticotropic hormone stimulation in subjects with primary aldosteronism. CONCLUSIONS Adrenal venous sampling operations with adrenocorticotropic hormone stimulation had significantly lower incorrect lateralisation, unsuccessful cannulations in both adrenal veins, unsuccessful cannulations of the left adrenal vein and unsuccessful cannulations of the right adrenal vein compared with adrenal venous sampling operations without adrenocorticotropic hormone stimulation in subjects with primary aldosteronism. Larger prospective studies are recommended to confirm these findings.
Collapse
Affiliation(s)
- Junfeng Yang
- Department of Urology, First People's Hospital of Yunnan Province, Kunming, China
| | - Yanhong Yu
- Department of Urology, First People's Hospital of Yunnan Province, Kunming, China
| | - Zhuorui Zhang
- Department of Urology, First People's Hospital of Yunnan Province, Kunming, China
| | - Yuerong Wu
- Department of Urology, First People's Hospital of Yunnan Province, Kunming, China
| | - Zhengyu He
- Department Of Urology, Yaan People's Hospital, Yaan, China
| |
Collapse
|
14
|
Yozamp N, Hundemer GL, Moussa M, Underhill J, Fudim T, Sacks B, Vaidya A. Adrenocorticotropic Hormone-Stimulated Adrenal Venous Sampling Underestimates Surgically Curable Primary Aldosteronism: A Retrospective Cohort Study and Review of Contemporary Studies. Hypertension 2021; 78:94-103. [PMID: 33993726 DOI: 10.1161/hypertensionaha.121.17248] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
[Figure: see text].
Collapse
Affiliation(s)
- Nicholas Yozamp
- From the Center for Adrenal Disorders, Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (N.Y., A.V.)
| | - Gregory L Hundemer
- Division of Nephrology, Department of Medicine and the Ottawa Hospital Research Institute, University of Ottawa, Canada (G.L.H.)
| | - Marwan Moussa
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (M.M., J.U., T.F., B.S.)
| | - Jonathan Underhill
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (M.M., J.U., T.F., B.S.)
| | - Tali Fudim
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (M.M., J.U., T.F., B.S.)
| | | | - Anand Vaidya
- From the Center for Adrenal Disorders, Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (N.Y., A.V.)
| |
Collapse
|
15
|
Hu J, Chen J, Cheng Q, Jing Y, Yang J, Du Z, Song Y, Ma L, Yang Y, Luo T, Wang Y, Li Q, Yang S. Comparison of Bolus and Continuous Infusion of Adrenocorticotropic Hormone During Adrenal Vein Sampling. Front Endocrinol (Lausanne) 2021; 12:784706. [PMID: 34899614 PMCID: PMC8662304 DOI: 10.3389/fendo.2021.784706] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 10/29/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Adrenocorticotropic hormone (ACTH) is widely used in adrenal vein sampling (AVS) and can be administered as a bolus injection or continuous infusion. The optimal administration method has not been determined. We aimed to compare the effects of ACTH bolus with infusion on cannulation success, lateralization assessment and adverse events (AEs). METHODS Retrospectively collected data from patients with primary aldosteronism who underwent AVS with ACTH at a tertiary hospital in China. Rate of successful cannulation, lateralization index (LI), complete biochemical remission and AEs related to AVS were analyzed. RESULTS The study included 80 patients receiving ACTH bolus and 94 receiving infusions. The rate of successful cannulation was comparable between bolus and infusion groups (75/80, 93.4% vs 88/94, 93.6%). In those with successful cannulation, the bolus group had a higher selectivity index than the infusion group, while LI [6.4(1.8-17.5) vs. 7.6(2.0-27.8), P=0.48] and rate of complete biochemical remission (43/44, 97.7% vs 53/53, 100%, P=0.45) did not significantly differ between the two groups. One in the bolus and one patient in the infusion group had adrenal vein rupture but they recovered with conservative treatment. The bolus group reported more transient AEs such as palpitation (52.9% vs 2.2%) and abdominal discomfort (40.0% vs 2.2%) than the infusion group. CONCLUSIONS Due to their similar effects on cannulation success and lateralization, but a lower rate of transient AEs in the infusion group, the continuous infusion method should be recommended for ACTH stimulation in AVS.
Collapse
Affiliation(s)
- Jinbo Hu
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jiangqiong Chen
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qingfeng Cheng
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Ying Jing
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jun Yang
- Department of Medicine, Monash University, Clayton, VIC, Australia
- Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Clayton, VIC, Australia
| | - Zhipeng Du
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Ying Song
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Linqiang Ma
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yi Yang
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Ting Luo
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yue Wang
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qifu Li
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- *Correspondence: Shumin Yang, ; Qifu Li,
| | - Shumin Yang
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- *Correspondence: Shumin Yang, ; Qifu Li,
| |
Collapse
|