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Evaluation of Adrenal Vein Sampling Use and Outcomes in Patients With Primary Aldosteronism.
J Surg Res. 2020 12; 256:673-679.JS

Abstract

BACKGROUND

Primary aldosteronism (PA) occurs in 10%-20% of patients with resistant hypertension. Guidelines recommend adrenal vein sampling (AVS) to identify patients for surgical management. We evaluate the use of AVS in managing PA to better understand the selection and outcomes of medical versus surgical treatment.

METHODS

A retrospective review was performed, and patients were divided into those who did (AVS) and did not have AVS (non-AVS). Demographics, aldosterone and renin levels, blood pressure, comorbidities, and antihypertensive medications were recorded. Reasons to defer AVS and medical versus surgical decision-making were examined and groups were compared.

RESULTS

We included 113 patients; 39.8% (45/113) had AVS, whereas 60.2% (68/113) did not. Groups were similar in age, body mass index, and initial systolic blood pressure (SBP). In patients who underwent AVS, 31 of 45 (68.9%) had unilateral secretion and were referred for surgery, whereas 13 of 45 (28.9%) had bilateral secretion. Of the 31 referred for surgery, 26 underwent laparoscopic adrenalectomy, all cured; four refused surgery; and one counseled toward medical management by their physician. In 68 non-AVS patients, 6 (8.8%) underwent adrenalectomy without sampling and 2 with no clinical improvement. The remaining deferrals were because of normal or bilateral adrenal nodules on imaging (8/68, 11.8%); medical management due to poor surgical candidacy (12/68, 17.6%); patient refusal of intervention (13/68, 19.1%); or reasons not stated (28/68, 41.1%). At the follow-up, patients who underwent AVS had lower median SBP (135.4 mmHg versus 144.7 mmHg, P = 0.0241) and shorter follow-up (17.7 mo versus 54.0 mo, P < 0.0001). Surgically managed patients had biochemical resolution of PA with normalization of potassium levels (3.6 to 4.7mEq/L, P < 0.00001).

CONCLUSIONS

AVS correctly selects patients for surgical management avoiding unnecessary surgery. However, despite guidelines, AVS is not always pursued as part of PA treatment, potentially excluding surgical candidates.

Authors+Show Affiliations

Albert Einstein College of Medicine, Bronx, New York. Electronic address: ayeung@mail.einstein.yu.edu.Department of Surgery, Montefore Medical Center, Bronx, New York.Surgical Oncology, Department of Surgery, Montefiore Medical Center, Bronx, New York.Endocrinology, Department of Medicine, Montefiore Medical Center, Bronx, New York.Surgical Oncology, Department of Surgery, Montefiore Medical Center, Bronx, New York.Rutgers Cancer Institute, New Brunswick, New Jersey.Endocrine Surgery, Rutgers Cancer Institute, New Brunswick, New Jersey.

Pub Type(s)

Comparative Study
Evaluation Study
Journal Article

Language

eng

PubMed ID

32827833

Citation

Yeung, Alyssa, et al. "Evaluation of Adrenal Vein Sampling Use and Outcomes in Patients With Primary Aldosteronism." The Journal of Surgical Research, vol. 256, 2020, pp. 673-679.
Yeung A, Friedmann P, In H, et al. Evaluation of Adrenal Vein Sampling Use and Outcomes in Patients With Primary Aldosteronism. J Surg Res. 2020;256:673-679.
Yeung, A., Friedmann, P., In, H., Bloomgarden, N., McAuliffe, J. C., Libutti, S. K., & Laird, A. M. (2020). Evaluation of Adrenal Vein Sampling Use and Outcomes in Patients With Primary Aldosteronism. The Journal of Surgical Research, 256, 673-679. https://doi.org/10.1016/j.jss.2020.05.099
Yeung A, et al. Evaluation of Adrenal Vein Sampling Use and Outcomes in Patients With Primary Aldosteronism. J Surg Res. 2020;256:673-679. PubMed PMID: 32827833.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Evaluation of Adrenal Vein Sampling Use and Outcomes in Patients With Primary Aldosteronism. AU - Yeung,Alyssa, AU - Friedmann,Patricia, AU - In,Haejin, AU - Bloomgarden,Noah, AU - McAuliffe,John C, AU - Libutti,Steven K, AU - Laird,Amanda M, Y1 - 2020/08/19/ PY - 2019/10/23/received PY - 2020/05/20/revised PY - 2020/05/27/accepted PY - 2020/8/23/pubmed PY - 2021/3/11/medline PY - 2020/8/23/entrez KW - AVS KW - Adrenal vein sampling KW - Conn's syndrome KW - Hyperaldosteronism KW - Primary aldosteronism SP - 673 EP - 679 JF - The Journal of surgical research JO - J Surg Res VL - 256 N2 - BACKGROUND: Primary aldosteronism (PA) occurs in 10%-20% of patients with resistant hypertension. Guidelines recommend adrenal vein sampling (AVS) to identify patients for surgical management. We evaluate the use of AVS in managing PA to better understand the selection and outcomes of medical versus surgical treatment. METHODS: A retrospective review was performed, and patients were divided into those who did (AVS) and did not have AVS (non-AVS). Demographics, aldosterone and renin levels, blood pressure, comorbidities, and antihypertensive medications were recorded. Reasons to defer AVS and medical versus surgical decision-making were examined and groups were compared. RESULTS: We included 113 patients; 39.8% (45/113) had AVS, whereas 60.2% (68/113) did not. Groups were similar in age, body mass index, and initial systolic blood pressure (SBP). In patients who underwent AVS, 31 of 45 (68.9%) had unilateral secretion and were referred for surgery, whereas 13 of 45 (28.9%) had bilateral secretion. Of the 31 referred for surgery, 26 underwent laparoscopic adrenalectomy, all cured; four refused surgery; and one counseled toward medical management by their physician. In 68 non-AVS patients, 6 (8.8%) underwent adrenalectomy without sampling and 2 with no clinical improvement. The remaining deferrals were because of normal or bilateral adrenal nodules on imaging (8/68, 11.8%); medical management due to poor surgical candidacy (12/68, 17.6%); patient refusal of intervention (13/68, 19.1%); or reasons not stated (28/68, 41.1%). At the follow-up, patients who underwent AVS had lower median SBP (135.4 mmHg versus 144.7 mmHg, P = 0.0241) and shorter follow-up (17.7 mo versus 54.0 mo, P < 0.0001). Surgically managed patients had biochemical resolution of PA with normalization of potassium levels (3.6 to 4.7mEq/L, P < 0.00001). CONCLUSIONS: AVS correctly selects patients for surgical management avoiding unnecessary surgery. However, despite guidelines, AVS is not always pursued as part of PA treatment, potentially excluding surgical candidates. SN - 1095-8673 UR - https://www.unboundmedicine.com/medline/citation/32827833/Evaluation_of_Adrenal_Vein_Sampling_Use_and_Outcomes_in_Patients_With_Primary_Aldosteronism_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0022-4804(20)30382-6 DB - PRIME DP - Unbound Medicine ER -