Should Adrenal Venous Sampling Be Performed in PA Patients Without Apparent Adrenal Tumors?

Frontiers in Endocrinology

Shoichiro Izawa¹  Akiyo Tanabe²  Mitsuhide Naruse³  Takamasa Ichijo⁴  Norio Wada⁵  Youichi Ohno⁶  Kentaro Okamoto⁶  Nobuya Inagaki⁶  Mika Tsuiki⁷  Takashi Yoneda⁸  Kouichi Tamura⁹  Kenji Oki^1,10  Masakatsu Sone^1,11  Hiroki Kobayashi^1,12 

[1] 0Division of Endocrinology and Metabolism, Tottori University Faculty of Medicine, Yonago, Japan;1Division of Endocrinology, National Center for Global Health and Medicine, Tokyo, Japan;2Endocrine Center, Ijinkai Takeda General Hospital, Kyoto, Japan;Department of Diabetes and Endocrinology, Saiseikai Yokohamashi Tobu Hospital, Yokohama, Japan;Department of Diabetes and Endocrinology, Sapporo City General Hospital, Sapporo, Japan;Department of Diabetes, Endocrinology and Nutrition, Kyoto University Graduate School of Medicine, Kyoto, Japan;Department of Endocrinology and Metabolism, National Hospital Organization Kyoto Medical Center, Kyoto, Japan;Department of Health Promotion and Medicine of the Future, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan;Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan;Department of Molecular and Internal Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan;Division of Metabolism and Endocrinology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan;Division of Nephrology, Hypertension and Endocrinology, Nihon University School of Medicine, Tokyo, Japan;

关键词: adrenalectomy;    adrenal venous sampling;    cardiovascular disease;    hyperaldosteronism;    primary aldosteronism;   

DOI  :  10.3389/fendo.2021.645395

来源: DOAJ

【 摘 要 】

IntroductionSome aldosterone-producing micro-adenomas cannot be detected through image inspection. Therefore, adrenal venous sampling (AVS) is often performed, even in primary aldosteronism (PA) patients who have no apparent adrenal tumors (ATs) on imaging. In most of these cases, however, the PA is bilateral.ObjectiveTo clarify the clinical need for AVS in PA patients without apparent ATs, taking into consideration the rates of adrenalectomy.MethodsThis is a retrospective cross-sectional study assessing 1586 PA patients without apparent ATs in the multicenter Japan PA study (JPAS). We analyzed which parameters could be used to distinguish unilateral PA patients without apparent ATs from bilateral patients. We also analyzed the prevalences of adrenalectomy in unilateral PA patients.ResultsThe unilateral subtype without an apparent AT was diagnosed in 200 (12.6%) of 1586 PA patients. Being young and female with a short hypertension duration, normokalemia, low creatinine level, low plasma aldosterone concentration, and low aldosterone-to-renin ratio (ARR) was significantly more common in bilateral than unilateral PA patients. If PA patients without apparent ATs were female and normokalemic with a low ARR (<560 pg/ml per ng/ml/h), the rate of unilateral PA was only 5 (1.1%) out of 444. Moreover, 77 (38.5%) of the 200 did not receive adrenalectomy, despite being diagnosed with the unilateral subtype based on AVS.ConclusionThe low prevalence of the unilateral subtype in PA patients without apparent ATs suggests AVS is not indicated for all of these patients. AVS could be skipped in female normokalemic PA patients without apparent ATs if their ARRs are not high. However, AVS should be considered for male hypokalemic PA patients with high ARRs because the rates of the unilateral subtype are high in these patients.

【 授权许可】

Unknown