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Adrenal Vein Sampling Lateralization Despite Mineralocorticoid Receptor Antagonists Exposure in Primary Aldosteronism.
J Clin Endocrinol Metab. 2019 02 01; 104(2):487-492.JC

Abstract

Context

Many antihypertensive medications modulate the renin-angiotensin-aldosterone system, possibly skewing the diagnosis and subtyping of primary aldosteronism (PA). Particularly, mineralocorticoid receptor antagonists (MRA) might raise renin and stimulate aldosterone synthesis from nonautonomous areas, potentially obscuring lateralization on adrenal vein sampling (AVS). Withdrawal of MRA in severe PA, however, can precipitate hypokalemia and/or hypertension and therefore is not always practical.

Objective

To assess the effects of MRA on the interpretation of AVS data.

Design and Participants

A cohort study of all PA patients who underwent AVS at University of Michigan between January 2009 and January 2018 was conducted. Demographics, diagnostic, AVS, surgical pathology, and follow-up data were collected retrospectively.

Results

Of 191 patients who underwent AVS, 51 (27%) were exposed to MRA at the time of the procedure. Plasma aldosterone concentration and the daily defined dose of antihypertensives were higher in patients taking vs those not taking MRA. Unilateral PA was more frequent in the MRA group, both precosyntropin and postcosyntropin (P < 0.05). The MRA group included two patients with unsuppressed renin, who demonstrated unequivocal AVS lateralization. To date, 86 patients underwent unilateral adrenalectomy, including 30 patients taking MRA during AVS. The proportion of clinical and biochemical success was not statistically different between patients exposed to and those not exposed to MRA during AVS (P = 0.17 and 0.65, respectively).

Conclusion

Our data suggest that conclusive AVS lateralization is often achieved in patients with severe PA despite MRA use.

Authors+Show Affiliations

Division of Metabolism, Endocrinology, and Diabetes, University of Michigan, Ann Arbor, Michigan.Division of Metabolism, Endocrinology, and Diabetes, University of Michigan, Ann Arbor, Michigan. Division of Endocrinology and Metabolism, Siriraj Hospital, Mahidol University, Bangkok, Thailand.Department of Radiology, University of Michigan, Ann Arbor, Michigan.Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan.Division of Metabolism, Endocrinology, and Diabetes, University of Michigan, Ann Arbor, Michigan. Department of Molecular and Integrative Physiology, University of Michigan, Ann Arbor, Michigan.Division of Metabolism, Endocrinology, and Diabetes, University of Michigan, Ann Arbor, Michigan. Department of Pharmacology, University of Michigan, Ann Arbor, Michigan.Division of Metabolism, Endocrinology, and Diabetes, University of Michigan, Ann Arbor, Michigan.

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

30239792

Citation

Nanba, Aya T., et al. "Adrenal Vein Sampling Lateralization Despite Mineralocorticoid Receptor Antagonists Exposure in Primary Aldosteronism." The Journal of Clinical Endocrinology and Metabolism, vol. 104, no. 2, 2019, pp. 487-492.
Nanba AT, Wannachalee T, Shields JJ, et al. Adrenal Vein Sampling Lateralization Despite Mineralocorticoid Receptor Antagonists Exposure in Primary Aldosteronism. J Clin Endocrinol Metab. 2019;104(2):487-492.
Nanba, A. T., Wannachalee, T., Shields, J. J., Byrd, J. B., Rainey, W. E., Auchus, R. J., & Turcu, A. F. (2019). Adrenal Vein Sampling Lateralization Despite Mineralocorticoid Receptor Antagonists Exposure in Primary Aldosteronism. The Journal of Clinical Endocrinology and Metabolism, 104(2), 487-492. https://doi.org/10.1210/jc.2018-01299
Nanba AT, et al. Adrenal Vein Sampling Lateralization Despite Mineralocorticoid Receptor Antagonists Exposure in Primary Aldosteronism. J Clin Endocrinol Metab. 2019 02 1;104(2):487-492. PubMed PMID: 30239792.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Adrenal Vein Sampling Lateralization Despite Mineralocorticoid Receptor Antagonists Exposure in Primary Aldosteronism. AU - Nanba,Aya T, AU - Wannachalee,Taweesak, AU - Shields,James J, AU - Byrd,James B, AU - Rainey,William E, AU - Auchus,Richard J, AU - Turcu,Adina F, PY - 2018/06/13/received PY - 2018/09/10/accepted PY - 2018/9/22/pubmed PY - 2019/12/18/medline PY - 2018/9/22/entrez SP - 487 EP - 492 JF - The Journal of clinical endocrinology and metabolism JO - J Clin Endocrinol Metab VL - 104 IS - 2 N2 - Context: Many antihypertensive medications modulate the renin-angiotensin-aldosterone system, possibly skewing the diagnosis and subtyping of primary aldosteronism (PA). Particularly, mineralocorticoid receptor antagonists (MRA) might raise renin and stimulate aldosterone synthesis from nonautonomous areas, potentially obscuring lateralization on adrenal vein sampling (AVS). Withdrawal of MRA in severe PA, however, can precipitate hypokalemia and/or hypertension and therefore is not always practical. Objective: To assess the effects of MRA on the interpretation of AVS data. Design and Participants: A cohort study of all PA patients who underwent AVS at University of Michigan between January 2009 and January 2018 was conducted. Demographics, diagnostic, AVS, surgical pathology, and follow-up data were collected retrospectively. Results: Of 191 patients who underwent AVS, 51 (27%) were exposed to MRA at the time of the procedure. Plasma aldosterone concentration and the daily defined dose of antihypertensives were higher in patients taking vs those not taking MRA. Unilateral PA was more frequent in the MRA group, both precosyntropin and postcosyntropin (P < 0.05). The MRA group included two patients with unsuppressed renin, who demonstrated unequivocal AVS lateralization. To date, 86 patients underwent unilateral adrenalectomy, including 30 patients taking MRA during AVS. The proportion of clinical and biochemical success was not statistically different between patients exposed to and those not exposed to MRA during AVS (P = 0.17 and 0.65, respectively). Conclusion: Our data suggest that conclusive AVS lateralization is often achieved in patients with severe PA despite MRA use. SN - 1945-7197 UR - https://www.unboundmedicine.com/medline/citation/30239792/Adrenal_Vein_Sampling_Lateralization_Despite_Mineralocorticoid_Receptor_Antagonists_Exposure_in_Primary_Aldosteronism_ L2 - https://academic.oup.com/jcem/article-lookup/doi/10.1210/jc.2018-01299 DB - PRIME DP - Unbound Medicine ER -