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.
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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)
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Chemical References |
- Aldosterone
- Hydrocortisone
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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
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