Surgical outcomes of patients with primary aldosteronism lateralized with I-131-6 β-iodomethyl-norcholesterol single photon emission/computed tomography without discontinuation or modification of antihypertensive medications
Objectives: Adrenocortical scintigraphy for patients with primary aldosteronism (PA) without discontinuation or modification of antihypertensive medications is of concern because of drug interference with the renin–angiotensin–aldosterone system. We report the surgical outcomes of patients with PA l...
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| Format: | Article |
| Language: | English |
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Wolters Kluwer Medknow Publications
2018-01-01
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| Series: | Tzu-Chi Medical Journal |
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| Online Access: | http://www.tcmjmed.com/article.asp?issn=1016-3190;year=2018;volume=30;issue=3;spage=169;epage=175;aulast=Chang |
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| author | Chia-Hui Chang Stephen Shei-Dei Yang Yao-Chou Tsai Shi-Wen Kuo Shiou-Chi Cherng Ching-Chu Lu Ruoh-Fang Yen Vin-Cent Wu Ya-Hui Hu |
| author_facet | Chia-Hui Chang Stephen Shei-Dei Yang Yao-Chou Tsai Shi-Wen Kuo Shiou-Chi Cherng Ching-Chu Lu Ruoh-Fang Yen Vin-Cent Wu Ya-Hui Hu |
| author_sort | Chia-Hui Chang |
| collection | DOAJ |
| description | Objectives: Adrenocortical scintigraphy for patients with primary aldosteronism (PA) without discontinuation or modification of antihypertensive medications is of concern because of drug interference with the renin–angiotensin–aldosterone system. We report the surgical outcomes of patients with PA lateralized with adrenocortical scintigraphy without drug discontinuation or modification. Materials and Methods: We retrospectively reviewed 34 patients with PA with computed tomography (CT)-documented adrenal tumors who had undergoing subsequent I-131-6 β-iodomethyl-norcholesterol (NP-59) single photon emission CT (SPECT)/CT followed by unilateral adrenalectomy according to the results of NP-59 uptake between May 2005 and December 2014. All enrolled patients underwent standard confirmatory tests and lateralization with NP-59 SPECT/CT without discontinuation of existing antihypertensive medications, including spironolactone. The pathological findings, hypertension outcomes, and biochemical changes were reported. The accuracy of NP-59 SPECT/CT without drug discontinuation or modification was also evaluated. Results: None of the 34 enrolled patients (M:F = 16:18) had complications such as a hypertensive crisis, life-threatening hypokalemic event, or cardiac arrhythmia. Pathology disclosed 31 (91%) adenomas and three cases of hyperplasia. Hypertension cure and improvement were observed in 12 (35%) and 18 (53%) patients, respectively. All of the 30 patients (100%) without postoperative use of beta-blockers and with an available postoperative aldosterone/renin ratio achieved a biochemical cure. The positive predictive values of NP-59 SPECT/CT were 91%, 88%, and 100% for the pathological findings, hypertension outcomes, and biochemical changes, respectively. Conclusion: Noninvasive NP-59 SPECT/CT without discontinuation or modification of antihypertensive medications not only provided accurate lateralization and safety but also resulted in a high improvement rate for PA-associated hypertension. |
| first_indexed | 2024-12-13T02:38:32Z |
| format | Article |
| id | doaj.art-af0ebb70fcd04583a3d054391d380f0b |
| institution | Directory Open Access Journal |
| issn | 1016-3190 2223-8956 |
| language | English |
| last_indexed | 2024-12-13T02:38:32Z |
| publishDate | 2018-01-01 |
| publisher | Wolters Kluwer Medknow Publications |
| record_format | Article |
| series | Tzu-Chi Medical Journal |
| spelling | doaj.art-af0ebb70fcd04583a3d054391d380f0b2022-12-22T00:02:22ZengWolters Kluwer Medknow PublicationsTzu-Chi Medical Journal1016-31902223-89562018-01-0130316917510.4103/tcmj.tcmj_106_17Surgical outcomes of patients with primary aldosteronism lateralized with I-131-6 β-iodomethyl-norcholesterol single photon emission/computed tomography without discontinuation or modification of antihypertensive medicationsChia-Hui ChangStephen Shei-Dei YangYao-Chou TsaiShi-Wen KuoShiou-Chi CherngChing-Chu LuRuoh-Fang YenVin-Cent WuYa-Hui HuObjectives: Adrenocortical scintigraphy for patients with primary aldosteronism (PA) without discontinuation or modification of antihypertensive medications is of concern because of drug interference with the renin–angiotensin–aldosterone system. We report the surgical outcomes of patients with PA lateralized with adrenocortical scintigraphy without drug discontinuation or modification. Materials and Methods: We retrospectively reviewed 34 patients with PA with computed tomography (CT)-documented adrenal tumors who had undergoing subsequent I-131-6 β-iodomethyl-norcholesterol (NP-59) single photon emission CT (SPECT)/CT followed by unilateral adrenalectomy according to the results of NP-59 uptake between May 2005 and December 2014. All enrolled patients underwent standard confirmatory tests and lateralization with NP-59 SPECT/CT without discontinuation of existing antihypertensive medications, including spironolactone. The pathological findings, hypertension outcomes, and biochemical changes were reported. The accuracy of NP-59 SPECT/CT without drug discontinuation or modification was also evaluated. Results: None of the 34 enrolled patients (M:F = 16:18) had complications such as a hypertensive crisis, life-threatening hypokalemic event, or cardiac arrhythmia. Pathology disclosed 31 (91%) adenomas and three cases of hyperplasia. Hypertension cure and improvement were observed in 12 (35%) and 18 (53%) patients, respectively. All of the 30 patients (100%) without postoperative use of beta-blockers and with an available postoperative aldosterone/renin ratio achieved a biochemical cure. The positive predictive values of NP-59 SPECT/CT were 91%, 88%, and 100% for the pathological findings, hypertension outcomes, and biochemical changes, respectively. Conclusion: Noninvasive NP-59 SPECT/CT without discontinuation or modification of antihypertensive medications not only provided accurate lateralization and safety but also resulted in a high improvement rate for PA-associated hypertension.http://www.tcmjmed.com/article.asp?issn=1016-3190;year=2018;volume=30;issue=3;spage=169;epage=175;aulast=ChangAdrenocortical scintigraphyDrug discontinuationI-131-6 β-iodomethyl-norcholesterol single photon emission computed tomography/computed tomographyPrimary aldosteronismSpironolactone |
| spellingShingle | Chia-Hui Chang Stephen Shei-Dei Yang Yao-Chou Tsai Shi-Wen Kuo Shiou-Chi Cherng Ching-Chu Lu Ruoh-Fang Yen Vin-Cent Wu Ya-Hui Hu Surgical outcomes of patients with primary aldosteronism lateralized with I-131-6 β-iodomethyl-norcholesterol single photon emission/computed tomography without discontinuation or modification of antihypertensive medications Tzu-Chi Medical Journal Adrenocortical scintigraphy Drug discontinuation I-131-6 β-iodomethyl-norcholesterol single photon emission computed tomography/computed tomography Primary aldosteronism Spironolactone |
| title | Surgical outcomes of patients with primary aldosteronism lateralized with I-131-6 β-iodomethyl-norcholesterol single photon emission/computed tomography without discontinuation or modification of antihypertensive medications |
| title_full | Surgical outcomes of patients with primary aldosteronism lateralized with I-131-6 β-iodomethyl-norcholesterol single photon emission/computed tomography without discontinuation or modification of antihypertensive medications |
| title_fullStr | Surgical outcomes of patients with primary aldosteronism lateralized with I-131-6 β-iodomethyl-norcholesterol single photon emission/computed tomography without discontinuation or modification of antihypertensive medications |
| title_full_unstemmed | Surgical outcomes of patients with primary aldosteronism lateralized with I-131-6 β-iodomethyl-norcholesterol single photon emission/computed tomography without discontinuation or modification of antihypertensive medications |
| title_short | Surgical outcomes of patients with primary aldosteronism lateralized with I-131-6 β-iodomethyl-norcholesterol single photon emission/computed tomography without discontinuation or modification of antihypertensive medications |
| title_sort | surgical outcomes of patients with primary aldosteronism lateralized with i 131 6 β iodomethyl norcholesterol single photon emission computed tomography without discontinuation or modification of antihypertensive medications |
| topic | Adrenocortical scintigraphy Drug discontinuation I-131-6 β-iodomethyl-norcholesterol single photon emission computed tomography/computed tomography Primary aldosteronism Spironolactone |
| url | http://www.tcmjmed.com/article.asp?issn=1016-3190;year=2018;volume=30;issue=3;spage=169;epage=175;aulast=Chang |
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