Does contralateral suppression at adrenal venous sampling predict outcome following unilateral adrenalectomy for primary aldosteronism? A retrospective study.

Abstract

CONTEXT:

In primary aldosteronism (PA), adrenal vein sampling (AVS) distinguishes unilateral and bilateral disease by comparison of aldosterone/cortisol (A/F) ratios. There is controversy about the criteria for interpretation, however, and in particular it is not clear whether contralateral suppression (CS) (defined as A/F(adrenal) ≤ A/F(peripheral) on the unaffected side) is important. We therefore performed a retrospective study to determine whether CS in surgically treated unilateral PA was associated with blood pressure (BP) and biochemical outcomes.

SETTING AND DESIGN:

Patients who underwent unilateral adrenalectomy for PA after successful AVS were included if the lateralization index (A/F(dominant):A/F(nondominant)) was ≥ 2. Cases were reviewed at 6 to 24 months follow-up for outcomes with respect to the presence and degree of CS.

RESULTS:

Sixty-six of 80 patients had CS. Baseline characteristics were similar. At postoperative follow-up, those with CS had lower systolic BP (SBP) (128 mm Hg vs 144 mm Hg, P = .001), a greater proportion with cure or improvement of hypertension (96% vs 64%, P = .0034), a greater proportion with biochemical cure of PA on fludrocortisone suppression testing (43 of 49 [88%] vs 4 of 9 [44%], P = .002) and were taking a lower median number of antihypertensive medications (0 vs 1.5, P = .0032). In a multivariate model, the degree of CS and preoperative SBP were both significantly correlated with postoperative SBP, but the lateralization index, sex, and age were not.

CONCLUSION:

In this study, the presence of CS correlated with good BP and biochemical outcomes from surgery. This finding suggests that CS should be a factor in deciding whether to offer surgery for treatment of PA.

• Authors: Martin J Wolley, Richard D Gordon, Ashraf H Ahmed, Michael Stowasser
• Journal: The Journal of clinical endocrinology and metabolism (J Clin Endocrinol Metab) Vol. 100 Issue 4 Pg. 1477-84 (Apr 2015) ISSN: 1945-7197 [Electronic] United States
• PMID: 25636049 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Aldosterone
• Hydrocortisone

Topics

• Adolescent
• Adrenal Glands (blood supply)
• Adrenalectomy
• Adult
• Aged
• Aldosterone (blood)
• Blood Specimen Collection
• Female
• Humans
• Hydrocortisone (blood)
• Hyperaldosteronism (blood, diagnosis, surgery)
• Male
• Middle Aged
• Predictive Value of Tests
• Prognosis
• Retrospective Studies
• Young Adult