Preoperative non-stimulated adrenal venous sampling index for predicting outcomes of adrenalectomy for unilateral primary aldosteronism

Chien-Wei Huang; Bo-Ching Lee; Kao-Lang Liu; Yeun-Chung Chang; Vin-Cent Wu; Po-Tsang Lee; Chin-Chen Chang; TAIPAI Study Group

doi:10.1016/j.jfma.2020.04.016

Preoperative non-stimulated adrenal venous sampling index for predicting outcomes of adrenalectomy for unilateral primary aldosteronism

J Formos Med Assoc. 2020 Jul;119(7):1185-1192. doi: 10.1016/j.jfma.2020.04.016. Epub 2020 May 5.

Authors

Chien-Wei Huang¹, Bo-Ching Lee², Kao-Lang Liu², Yeun-Chung Chang², Vin-Cent Wu³, Po-Tsang Lee⁴, Chin-Chen Chang⁵; TAIPAI Study Group

Affiliations

¹ Division of Nephrology, Department of Medicine, Kaohsiung Veterans General Hospital, and National Yang-Ming University, School of Medicine, Taiwan; Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
² Department of Medical Imaging, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
³ Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
⁴ Division of Nephrology, Department of Medicine, Kaohsiung Veterans General Hospital, and National Yang-Ming University, School of Medicine, Taiwan.
⁵ Department of Medical Imaging, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan; Department and Graduate Institute of Forensic Medicine, National Taiwan University College of Medicine, Taipei, Taiwan. Electronic address: macotocc@gmail.com.

PMID: 32386674
DOI: 10.1016/j.jfma.2020.04.016

Abstract

Background/purpose: The aim of this study was to predict outcomes of adrenalectomy for unilateral primary aldosteronism (PA) using non-stimulated adrenal venous sampling (AVS) indices and the standardized Primary Aldosteronism Surgical Outcome (PASO) criteria.

Methods: Patients with unilateral PA who underwent adrenalectomy based on non-stimulated AVS and had follow-up data regarding surgical outcomes between 2011 and 2016 were enrolled. Demographic data and non-stimulated AVS indices, including lateralization index (LI) and contralateral suppression, were collected for analysis.

Results: This study included 54 patients who underwent adrenalectomy. Clinical and biochemical outcomes were evaluated in all patients and in 52 (96.3%) patients, respectively. Complete clinical and biochemical success was achieved in 31 (57.4%) of 54 patients and 42 (80.8%) of 52 patients, respectively. An LI > 4 was significantly associated with complete clinical and biochemical success (OR = 4.30, 95% CI 1.18-15.68, p = 0.03, and OR = 7.55, 95% CI 1.28-44.47, p = 0.03, respectively). Contralateral suppression was an independent predictor of complete biochemical success (OR = 17.27, 95% CI 1.95-153.21, p = 0.01).

Conclusion: Non-stimulated AVS indices including LI and contralateral suppression are reliable preoperative determinants for predicting the outcomes of adrenalectomy in patients with unilateral PA. Our findings provide more evidence and confidence to clinicians when applying non-stimulated AVS to determine PA treatment.

Keywords: Adrenalectomy; Primary hyperaldosteronism; Prognostic factors; Venography.

MeSH terms

Adrenal Glands / surgery
Adrenalectomy*
Humans
Hyperaldosteronism* / diagnosis
Hyperaldosteronism* / surgery
Prognosis
Retrospective Studies
Treatment Outcome