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Rossitto G, Amar L, Azizi M, Riester A, Reincke M, Degenhart C, Widimsky J, Naruse M, Deinum J, Schultzekool L, Kocjan T, Negro A, Rossi E, Kline G, Tanabe A, Satoh F, Rump LC, Vonend O, Willenberg HS, Fuller P, Yang J, Nian Chee NY, Magill SB, Shafigullina Z, Quinkler M, Oliveras A, Chang CC, Wu VC, Somloova Z, Maiolino G, Barbiero G, Battistel M, Lenzini L, Quaia E, Pessina AC, Rossi GP. Subtyping of Primary Aldosteronism in the AVIS-2 Study: Assessment of Selectivity and Lateralization. J Clin Endocrinol Metab 2020; 105:5571856. [PMID: 31536622 DOI: 10.1210/clinem/dgz017] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 09/18/2019] [Indexed: 01/21/2023]
Abstract
CONTEXT Adrenal venous sampling (AVS) is the key test for subtyping primary aldosteronism (PA), but its interpretation varies widely across referral centers and this can adversely affect the management of PA patients. OBJECTIVES To investigate in a real-life study the rate of bilateral success and identification of unilateral aldosteronism and their impact on blood pressure outcomes in PA subtyped by AVS. DESIGN AND SETTINGS In a retrospective analysis of the largest international registry of individual AVS data (AVIS-2 study), we investigated how different cut-off values of the selectivity index (SI) and lateralization index (LI) affected rate of bilateral success, identification of unilateral aldosteronism, and blood pressure outcomes. RESULTS AVIS-2 recruited 1625 individual AVS studies performed between 2000 and 2015 in 19 tertiary referral centers. Under unstimulated conditions, the rate of biochemically confirmed bilateral AVS success progressively decreased with increasing SI cut-offs; furthermore, with currently used LI cut-offs, the rate of identified unilateral PA leading to adrenalectomy was as low as <25%. A within-patient pairwise comparison of 402 AVS performed both under unstimulated and cosyntropin-stimulated conditions showed that cosyntropin increased the confirmed rate of bilateral selectivity for SI cut-offs ≥ 2.0, but reduced lateralization rates (P < 0.001). Post-adrenalectomy outcomes were not improved by use of cosyntropin or more restrictive diagnostic criteria. CONCLUSION Commonly used SI and LI cut-offs are associated with disappointingly low rates of biochemically defined AVS success and identified unilateral PA. Evidence-based protocols entailing less restrictive interpretative cut-offs might optimize the clinical use of this costly and invasive test. (J Clin Endocrinol Metab XX: 0-0, 2020).
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Affiliation(s)
- Giacomo Rossitto
- Department of Medicine-DIMED, University Hospital, Padova, Italy
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Laurence Amar
- Hypertension unit, Université de Paris, Inserm UMR970 and CIC1418, Hôpital Européen Georges Pompidou, Paris, France
| | - Michel Azizi
- Hypertension unit, Université de Paris, Inserm UMR970 and CIC1418, Hôpital Européen Georges Pompidou, Paris, France
| | - Anna Riester
- Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, LMU München, München, Germany
| | - Martin Reincke
- Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, LMU München, München, Germany
| | - Christoph Degenhart
- Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, LMU München, München, Germany
| | - Jiri Widimsky
- 3rd Department of Medicine, Charles University Prague, General Hospital, Prague, Czech Republic
| | - Mitsuhide Naruse
- Department of Endocrinology, Clinical Research Institute, NHO Kyoto Medical Center and Endocrine Center, Ijinkai Takeda General Hospital, Kyoto, Japan
| | - Jaap Deinum
- Departments of Internal Medicine and Radiology, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - Leo Schultzekool
- Departments of Internal Medicine and Radiology, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - Tomaz Kocjan
- Department of Endocrinology, Diabetes and Metabolic Diseases, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Aurelio Negro
- Department of Internal Medicine, Azienda Unità Sanitaria Locale, IRCCS Arcispedale S. Maria Nuova, Reggio Emilia, Italy
| | - Ermanno Rossi
- Department of Internal Medicine, Azienda Unità Sanitaria Locale, IRCCS Arcispedale S. Maria Nuova, Reggio Emilia, Italy
| | - Gregory Kline
- University of Calgary, Foothills Medical Centre, Calgary, Canada
| | - Akiyo Tanabe
- Department of Diabetes, Endocrinology and Metabolism, National Center for Global Health and Medicine (NCGHM), Tokyo, Japan
| | - Fumitoshi Satoh
- Department of Nephrology, Tohoku University Hospital, Endocrinology and Vascular Medicine, Sendai, Japan
| | - Lars Christian Rump
- Department of Nephrology, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Oliver Vonend
- Department of Nephrology, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Holger S Willenberg
- Division of Endocrinology and Metabolism, Rostock University Medical Center, Rostock, Germany
| | - Peter Fuller
- Department of Endocrinology, Monash Health, Clayton, Australia
| | - Jun Yang
- Department of Endocrinology, Monash Health, Clayton, Australia
| | | | - Steven B Magill
- Medical College of Wisconsin, Endocrinology Center, North Hills Health Center, Menomonee Falls, Wisconsin
| | - Zulfiya Shafigullina
- Department of Endocrinology, North-Western State Medical University named after I.I. Mechnikov, St. Petersburg, Russia
| | | | - Anna Oliveras
- Nephrology Department, Hospital del Mar Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Chin-Chen Chang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Vin Cent Wu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Zusana Somloova
- 3rd Department of Medicine, Charles University Prague, General Hospital, Prague, Czech Republic
| | | | | | | | - Livia Lenzini
- Department of Medicine-DIMED, University Hospital, Padova, Italy
| | - Emilio Quaia
- Institute of Radiology, University of Padova, Padova, Italy
| | | | - Gian Paolo Rossi
- Department of Medicine-DIMED, University Hospital, Padova, Italy
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