1. Adrenalectomy for Primary Aldosteronism
- Author
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Vorselaars, W.M.C.M., van Beek, D.J., Suurd, D.P.D., Postma, E., Spiering, W., Rinkes, I.H.M.B., Valk, G.D., Vriens, M.R., Zarnegar, R., Fahey, T.J., Drake, F.T., Duh, Q.Y., Talutis, S.D., McAneny, D.B., McManus, C., Lee, J.M.A., Grant, S.B., Grogan, R.H., Arenas, M.R.A., Perrier, N.D., Sturgeon, C., Castelino, T., Mitmaker, E.J., Parente, D.N., Pasternak, J.D., Sidhu, S.B., Sywak, M., D'Amato, G., Raffaelli, M., Schuermans, V., Bouvy, N.D., Eker, H.H., Bonjer, H.J., Engelsman, A.F., van Dijkum, E.J.M.N., Kerstens, M.N., Kruijff, S., MUMC+: MA AIOS Neurochirurgie (9), Surgery, MUMC+: MA Heelkunde (9), RS: NUTRIM - R2 - Liver and digestive health, Amsterdam Gastroenterology Endocrinology Metabolism, and Guided Treatment in Optimal Selected Cancer Patients (GUTS)
- Subjects
Adult ,Male ,medicine.medical_specialty ,medicine.medical_treatment ,030209 endocrinology & metabolism ,030204 cardiovascular system & hematology ,DIAGNOSIS ,PRIMARY HYPERALDOSTERONISM ,SALINE INFUSION TEST ,PREFERRED METHOD ,03 medical and health sciences ,0302 clinical medicine ,Primary aldosteronism ,Internal medicine ,PRO SIDE ,Hyperaldosteronism ,Renin ,medicine ,Humans ,Aldosterone ,Aged ,OUTCOMES ,HYPERTENSION ,business.industry ,Adrenalectomy ,Guideline ,Vascular surgery ,Middle Aged ,medicine.disease ,Magnetic Resonance Imaging ,Work-up ,PREVALENCE ,Cardiothoracic surgery ,CONFIRMATORY TESTS ,Cohort ,Surgery ,Female ,Guideline Adherence ,SELECT PATIENTS ,business ,Tomography, X-Ray Computed ,Abdominal surgery - Abstract
Background Various diagnostic tests are available to establish the primary aldosteronism (PA) diagnosis and to determine the disease laterality. Combined with the controversies in the literature, unawareness of guidelines and technical demands and high costs of some of these diagnostics, this could lead to significant differences in work-up strategies worldwide. Therefore, we investigated the work-up before surgery for PA in daily clinical practice within a multicenter study. Methods Patients who underwent unilateral adrenalectomy for PA within 16 centers in Europe, Canada, Australia and the USA between 2010 and 2016 were included. We did not exclude patients based on the performed diagnostic tests during work-up to make our data representative for current clinical practice. Adherence to the Endocrine Society Guideline and variables associated with not performing adrenal venous sampling (AVS) were analyzed. Results In total, 435 patients were eligible. An aldosterone-to-renin ratio, confirmatory test, computed tomography (CT), magnetic resonance imaging and AVS were performed in 82.9%, 32.9%, 86.9%, 17.0% and 65.3% of patients, respectively. A complete work-up, as recommended by the guideline, was performed in 13.1% of patients. Bilateral disease or normal adrenal anatomy on CT (OR 16.19; CI 3.50–74.99), smaller tumor size on CT (OR 0.06; CI 0.04–0.08) and presence of hypokalemia (OR 2.00; CI 1.19–3.32) were independently associated with performing AVS. Conclusions This study is the first to examine the daily clinical practice work-up of PA within a worldwide cohort of surgical patients. The results demonstrate significant variability in work-up strategies and low adherence to The Endocrine Society guideline.
- Published
- 2020
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