Adrenal Venous Sampling-Guided Adrenalectomy Rates in Primary Aldosteronism: Results of an International Cohort (AVSTAT).

Abstract

CONTEXT:

Adrenal venous sampling (AVS) is the current criterion standard lateralization technique in primary aldosteronism (PA). Japanese registry data found that 30% of patients with unilateral PA did not undergo adrenalectomy, but the reasons for this and whether the same pattern is seen internationally are unknown.

OBJECTIVE:

To assess the rate of AVS-guided adrenalectomy across an international cohort and identify factors that resulted in adrenalectomy not being performed in otherwise eligible patients.

DESIGN, SETTING, AND PARTICIPANTS:

Retrospective, multinational, multicenter questionnaire-based survey of management of PA patients from 16 centers between 2006 and 2018.

MAIN OUTCOME MEASURES:

Rates of AVS implementation, AVS success rate, diagnosis of unilateral PA, adrenalectomy rate, and reasons why adrenalectomy was not undertaken in patients with unilateral PA.

RESULTS:

Rates of AVS implementation, successful AVS, and unilateral disease were 66.3%, 89.3% and 36.9% respectively in 4818 patients with PA. Unilateral PA and adrenalectomy rate in unilateral PA were lower in Japanese than in European centers (24.0% vs 47.6% and 78.2% vs 91.4% respectively). The clinical reasoning for not performing adrenalectomy in unilateral PA were more likely to be physician-derived in Japan and patient-derived in Europe. Physician-derived factors included non-AVS factors, such as good blood pressure control, normokalemia, and the absence of adrenal lesions on imaging, which were present before AVS.

CONCLUSION:

Considering the various unfavorable aspects of AVS, stricter implementation and consideration of surgical candidacy prior to AVS will increase its diagnostic efficiency and utility.

• Authors: Youichi Ohno, Mitsuhide Naruse, Felix Beuschlein, Florentine Schreiner, Mirko Parasiliti-Caprino, Jaap Deinum, William M Drake, Francesco Fallo, Carmina T Fuss, Marianne A Grytaas, Takamasa Ichijo, Nobuya Inagaki, Miki Kakutani, Darko Kastelan, Ivana Kraljevic, Takuyuki Katabami, Tomaz Kocjan, Silvia Monticone, Paolo Mulatero, Sam O'Toole, Hiroki Kobayashi, Masakatsu Sone, Mika Tsuiki, Norio Wada, Tracy Ann Williams, Martin Reincke, Akiyo Tanabe
• Journal: The Journal of clinical endocrinology and metabolism (J Clin Endocrinol Metab) Vol. 106 Issue 3 Pg. e1400-e1407 (03 08 2021) ISSN: 1945-7197 [Electronic] United States
• PMID: 33031550 (Publication Type: Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't)
• Copyright: © The Author(s) 2020. Published by Oxford University Press on behalf of the Endocrine Society. All rights reserved. For permissions, please e-mail: [email protected].

Topics

• Adrenal Glands (blood supply)
• Adrenalectomy (adverse effects, methods, statistics & numerical data)
• Blood Specimen Collection (methods, statistics & numerical data)
• Cohort Studies
• Europe (epidemiology)
• Humans
• Hyperaldosteronism (blood, diagnosis, epidemiology, surgery)
• Japan (epidemiology)
• Practice Patterns, Physicians' (statistics & numerical data)
• Preoperative Care (methods, statistics & numerical data)
• Retrospective Studies
• Surveys and Questionnaires
• Treatment Outcome