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Feasibility of Imaging-Guided Adrenalectomy in Young Patients With Primary Aldosteronism
- Source :
- Hypertension, 79, 1, pp. 187-195, Hypertension, 79, 187-195
- Publication Year :
- 2021
-
Abstract
- Many of the patients with primary aldosteronism (PA) are denied curative adrenalectomy because of limited availability or failure of adrenal vein sampling. It has been suggested that adrenal vein sampling can be omitted in young patients with a unilateral adrenal nodule, who show a florid biochemical PA phenotype. As this suggestion was based on a very low quality of evidence, we tested the applicability and accuracy of imaging, performed by computed tomography and/or magnetic resonance, for identification of unilateral PA, as determined by biochemical and/or clinical cure after unilateral adrenalectomy. Among 1625 patients with PA submitted to adrenal vein sampling in a multicenter multiethnic international study, 473 were ≤45 years of age; 231 of them had exhaustive imaging and follow-up data. Fifty-three percentage had a unilateral adrenal nodule, 43% had no nodules, and 4% bilateral nodules. Fifty-six percentage (n=131) received adrenalectomy and 128 were unambiguously diagnosed as unilateral PA. A unilateral adrenal nodule on imaging and hypokalemia were the strongest predictors of unilateral PA at regression analysis. Accordingly, imaging allowed correct identification of the responsible adrenal in 95% of the adrenalectomized patients with a unilateral nodule. The rate raised to 100% in the patients with hypokalemia, who comprised 29% of the total, but fell to 88% in those without hypokalemia. Therefore, a unilateral nodule and hypokalemia could be used to identify unilateral PA in patients ≤45 years of age if adrenal vein sampling is not easily available. However, adrenal vein sampling remains indispensable in 71% of the young patients, who showed no nodules/bilateral nodules at imaging and/or no hypokalemia. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT01234220.
- Subjects :
- Adult
Male
medicine.medical_specialty
medicine.medical_treatment
Vascular damage Radboud Institute for Health Sciences [Radboudumc 16]
Urology
Hypokalemia
chemistry.chemical_compound
Computer-Assisted
Primary aldosteronism
All institutes and research themes of the Radboud University Medical Center
Diagnosis
Adrenal Glands
Hyperaldosteronism
Internal Medicine
medicine
Humans
Aldosterone
Tomography
Retrospective Studies
Blood Specimen Collection
business.industry
Adrenalectomy
Hypertension
Phenotype
Feasibility Studies
Female
Magnetic Resonance Imaging
Middle Aged
Surgery, Computer-Assisted
Tomography, X-Ray Computed
Adrenal vein
medicine.disease
X-Ray Computed
chemistry
Adrenal vein sampling
Surgery
medicine.symptom
business
Subjects
Details
- ISSN :
- 15244563 and 0194911X
- Volume :
- 79
- Issue :
- 1
- Database :
- OpenAIRE
- Journal :
- Hypertension (Dallas, Tex. : 1979)
- Accession number :
- edsair.doi.dedup.....99c0cf34f8ced4e47be6db06a57d7c1c