The Concordance Between Imaging and Adrenal Vein Sampling Varies With Aldosterone-Driver Somatic Mutation

J Clin Endocrinol Metab. 2020 Oct 1;105(10):e3628-e3637. doi: 10.1210/clinem/dgaa482.

Abstract

Background: Correct subtyping of primary aldosteronism (PA) is critical for guiding clinical management. Adrenal imaging is less accurate than adrenal vein sampling (AVS); nonetheless, AVS is invasive, technically challenging, and scarcely available.

Objective: To identify predictors of concordance between cross-sectional imaging and lateralized AVS in patients with PA that could help circumvent AVS in a subset of patients.

Methods: We retrospectively studied all patients with PA who underwent AVS in a tertiary referral center from 2009 to 2019. AVS was performed before and after cosyntropin stimulation. Patients with lateralized AVS in at least one condition were included. Aldosterone synthase-guided next-generation sequencing was performed on available adrenal tissue. Logistic regression was implemented to identify predictors of imaging-AVS lateralization concordance.

Results: A total of 234 patients (62% men), age 20 to 79 years, 73% white, 23% black, and 2% Asian were included. AVS lateralization was found: 1) both pre- and post-cosyntropin (Uni/Uni) in 138 patients; 2) only at baseline (Uni/Bi) in 39 patients; 3) only after cosyntropin stimulation (Bi/Uni) in 29 patients. Catheterization partially failed in 28 patients. AVS-imaging agreement was higher in patients with KCNJ5 versus other aldosterone-driver somatic mutations (90.3% versus 64.6%; P < 0.001); in Asian and white versus black Americans (75%, 70%, and 36%, respectively); in younger patients; and those with left adrenal nodules and contralateral suppression. Conversely, AVS-imaging agreement was lowest in Uni/Bi patients (38% vs. 69% in Uni/Uni, and 62% in Bi/Uni; P = 0.007).

Conclusions: While AVS-imaging agreement is higher in young white and Asian patients, who have KCNJ5-mutated aldosterone producing adenomas, no predictor confers absolute imaging accuracy.

Keywords: adrenal; adrenal vein sampling; aldosterone; computed tomography; imaging; primary aldosteronism.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adrenal Cortex Function Tests / methods
  • Adrenal Cortex Neoplasms / blood
  • Adrenal Cortex Neoplasms / complications
  • Adrenal Cortex Neoplasms / diagnosis*
  • Adrenal Cortex Neoplasms / genetics
  • Adrenal Glands / blood supply
  • Adrenal Glands / diagnostic imaging*
  • Adrenal Glands / drug effects
  • Adrenocortical Adenoma / blood
  • Adrenocortical Adenoma / complications
  • Adrenocortical Adenoma / diagnosis*
  • Adrenocortical Adenoma / genetics
  • Adult
  • Aged
  • Aldosterone / blood*
  • Aldosterone / metabolism
  • Cosyntropin / administration & dosage
  • Female
  • G Protein-Coupled Inwardly-Rectifying Potassium Channels / genetics
  • Humans
  • Hyperaldosteronism / diagnosis*
  • Hyperaldosteronism / genetics
  • Male
  • Middle Aged
  • Mutation
  • Reproducibility of Results
  • Retrospective Studies
  • Young Adult

Substances

  • G Protein-Coupled Inwardly-Rectifying Potassium Channels
  • KCNJ5 protein, human
  • Cosyntropin
  • Aldosterone