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Outcome of adrenal vein sampling performed during concurrent mineralocorticoid receptor antagonist therapy.
J Clin Endocrinol Metab. 2014 Dec; 99(12):4397-402.JC

Abstract

CONTEXT

Pharmacological inhibition of mineralocorticoid receptor (MR) signaling in patients with primary aldosteronism (PA) reestablishes aldosterone synthesis by nondiseased zona glomerulosa cells through activation of the renin-angiotensin-aldosterone system. In this context, current guidelines recommend discontinuing MR blockade for diagnostic procedures, including adrenal vein sampling (AVS). Discontinuation of MR blockade in high-risk patients may be harmful because of uncontrolled hypertension and severe hypokalemia. We hypothesize that MR antagonist therapy can be continued during AVS as long as renin levels remain suppressed.

OBJECTIVE

The objective of this study was to assess the validity of AVS results in the context of MR antagonistic therapy.

DESIGN

We retrospectively analyzed all AVS studies in Munich (since 2008) and Düsseldorf (since 2011) and identified four of 237 (1.7%) patients with PA who underwent AVS while treated with an MR antagonist. Adrenalectomy was recommended based on the results of AVS in all four patients. After adrenalectomy, follow-up data were obtained to confirm improvement or remission of PA. Main outcome measures included blood pressure values, daily defined doses of antihypertensive medication, as well as levels of aldosterone, renin, and potassium, and the aldosterone/renin ratio.

RESULTS

In all patients, renin remained low or suppressed during AVS despite MR antagonist treatment. AVS clearly demonstrated unilateral aldosterone excess in each case. After adrenalectomy, all patients showed remission of PA as demonstrated by blood pressure values, potassium levels, and the aldosterone/renin ratio.

CONCLUSION

In selected cases of PA, MR antagonist therapy might be continued during AVS, provided that renin values remain low.

Authors+Show Affiliations

Division for Specific Endocrinology (M.H., H.S.W.), and Department of Diagnostic and Interventional Radiology (P.K.), Medical Faculty, University Duesseldorf, D-40225 Duesseldorf, Germany; Medizinische Klinik und Poliklinik IV (A.R., M.R.), and Department of Radiology (C.D.), Hospital of the Ludwig Maximilians University, D-80336 Munich, Germany; and Endocrinology and Diabetes Unit (S.H.), Department of Medicine I, University Hospital Wuerzburg, D-97080 Wuerzburg, Germany.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Case Reports
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

25222758

Citation

Haase, Matthias, et al. "Outcome of Adrenal Vein Sampling Performed During Concurrent Mineralocorticoid Receptor Antagonist Therapy." The Journal of Clinical Endocrinology and Metabolism, vol. 99, no. 12, 2014, pp. 4397-402.
Haase M, Riester A, Kröpil P, et al. Outcome of adrenal vein sampling performed during concurrent mineralocorticoid receptor antagonist therapy. J Clin Endocrinol Metab. 2014;99(12):4397-402.
Haase, M., Riester, A., Kröpil, P., Hahner, S., Degenhart, C., Willenberg, H. S., & Reincke, M. (2014). Outcome of adrenal vein sampling performed during concurrent mineralocorticoid receptor antagonist therapy. The Journal of Clinical Endocrinology and Metabolism, 99(12), 4397-402. https://doi.org/10.1210/jc.2014-2788
Haase M, et al. Outcome of Adrenal Vein Sampling Performed During Concurrent Mineralocorticoid Receptor Antagonist Therapy. J Clin Endocrinol Metab. 2014;99(12):4397-402. PubMed PMID: 25222758.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Outcome of adrenal vein sampling performed during concurrent mineralocorticoid receptor antagonist therapy. AU - Haase,Matthias, AU - Riester,Anna, AU - Kröpil,Patric, AU - Hahner,Stefanie, AU - Degenhart,Christoph, AU - Willenberg,Holger S, AU - Reincke,Martin, PY - 2014/9/16/entrez PY - 2014/9/16/pubmed PY - 2015/10/8/medline SP - 4397 EP - 402 JF - The Journal of clinical endocrinology and metabolism JO - J Clin Endocrinol Metab VL - 99 IS - 12 N2 - CONTEXT: Pharmacological inhibition of mineralocorticoid receptor (MR) signaling in patients with primary aldosteronism (PA) reestablishes aldosterone synthesis by nondiseased zona glomerulosa cells through activation of the renin-angiotensin-aldosterone system. In this context, current guidelines recommend discontinuing MR blockade for diagnostic procedures, including adrenal vein sampling (AVS). Discontinuation of MR blockade in high-risk patients may be harmful because of uncontrolled hypertension and severe hypokalemia. We hypothesize that MR antagonist therapy can be continued during AVS as long as renin levels remain suppressed. OBJECTIVE: The objective of this study was to assess the validity of AVS results in the context of MR antagonistic therapy. DESIGN: We retrospectively analyzed all AVS studies in Munich (since 2008) and Düsseldorf (since 2011) and identified four of 237 (1.7%) patients with PA who underwent AVS while treated with an MR antagonist. Adrenalectomy was recommended based on the results of AVS in all four patients. After adrenalectomy, follow-up data were obtained to confirm improvement or remission of PA. Main outcome measures included blood pressure values, daily defined doses of antihypertensive medication, as well as levels of aldosterone, renin, and potassium, and the aldosterone/renin ratio. RESULTS: In all patients, renin remained low or suppressed during AVS despite MR antagonist treatment. AVS clearly demonstrated unilateral aldosterone excess in each case. After adrenalectomy, all patients showed remission of PA as demonstrated by blood pressure values, potassium levels, and the aldosterone/renin ratio. CONCLUSION: In selected cases of PA, MR antagonist therapy might be continued during AVS, provided that renin values remain low. SN - 1945-7197 UR - https://www.unboundmedicine.com/medline/citation/25222758/Outcome_of_adrenal_vein_sampling_performed_during_concurrent_mineralocorticoid_receptor_antagonist_therapy_ L2 - https://academic.oup.com/jcem/article-lookup/doi/10.1210/jc.2014-2788 DB - PRIME DP - Unbound Medicine ER -