Should Adrenal Venous Sampling Be Performed in PA Patients Without Apparent Adrenal Tumors?
IntroductionSome aldosterone-producing micro-adenomas cannot be detected through image inspection. Therefore, adrenal venous sampling (AVS) is often performed, even in primary aldosteronism (PA) patients who have no apparent adrenal tumors (ATs) on imaging. In most of these cases, however, the PA is...
| Main Authors: | , , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Frontiers Media S.A.
2021-04-01
|
| Series: | Frontiers in Endocrinology |
| Subjects: | |
| Online Access: | https://www.frontiersin.org/articles/10.3389/fendo.2021.645395/full |
| _version_ | 1818412479817973760 |
|---|---|
| author | Kentaro Okamoto Youichi Ohno Masakatsu Sone Masakatsu Sone Nobuya Inagaki Takamasa Ichijo Takashi Yoneda Mika Tsuiki Norio Wada Kenji Oki Kouichi Tamura Hiroki Kobayashi Shoichiro Izawa Akiyo Tanabe Mitsuhide Naruse Mitsuhide Naruse |
| author_facet | Kentaro Okamoto Youichi Ohno Masakatsu Sone Masakatsu Sone Nobuya Inagaki Takamasa Ichijo Takashi Yoneda Mika Tsuiki Norio Wada Kenji Oki Kouichi Tamura Hiroki Kobayashi Shoichiro Izawa Akiyo Tanabe Mitsuhide Naruse Mitsuhide Naruse |
| author_sort | Kentaro Okamoto |
| collection | DOAJ |
| description | IntroductionSome aldosterone-producing micro-adenomas cannot be detected through image inspection. Therefore, adrenal venous sampling (AVS) is often performed, even in primary aldosteronism (PA) patients who have no apparent adrenal tumors (ATs) on imaging. In most of these cases, however, the PA is bilateral.ObjectiveTo clarify the clinical need for AVS in PA patients without apparent ATs, taking into consideration the rates of adrenalectomy.MethodsThis is a retrospective cross-sectional study assessing 1586 PA patients without apparent ATs in the multicenter Japan PA study (JPAS). We analyzed which parameters could be used to distinguish unilateral PA patients without apparent ATs from bilateral patients. We also analyzed the prevalences of adrenalectomy in unilateral PA patients.ResultsThe unilateral subtype without an apparent AT was diagnosed in 200 (12.6%) of 1586 PA patients. Being young and female with a short hypertension duration, normokalemia, low creatinine level, low plasma aldosterone concentration, and low aldosterone-to-renin ratio (ARR) was significantly more common in bilateral than unilateral PA patients. If PA patients without apparent ATs were female and normokalemic with a low ARR (<560 pg/ml per ng/ml/h), the rate of unilateral PA was only 5 (1.1%) out of 444. Moreover, 77 (38.5%) of the 200 did not receive adrenalectomy, despite being diagnosed with the unilateral subtype based on AVS.ConclusionThe low prevalence of the unilateral subtype in PA patients without apparent ATs suggests AVS is not indicated for all of these patients. AVS could be skipped in female normokalemic PA patients without apparent ATs if their ARRs are not high. However, AVS should be considered for male hypokalemic PA patients with high ARRs because the rates of the unilateral subtype are high in these patients. |
| first_indexed | 2024-12-14T10:47:58Z |
| format | Article |
| id | doaj.art-bc7ceb478f4b44abad4535574cb7de00 |
| institution | Directory Open Access Journal |
| issn | 1664-2392 |
| language | English |
| last_indexed | 2024-12-14T10:47:58Z |
| publishDate | 2021-04-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Endocrinology |
| spelling | doaj.art-bc7ceb478f4b44abad4535574cb7de002022-12-21T23:05:22ZengFrontiers Media S.A.Frontiers in Endocrinology1664-23922021-04-011210.3389/fendo.2021.645395645395Should Adrenal Venous Sampling Be Performed in PA Patients Without Apparent Adrenal Tumors?Kentaro Okamoto0Youichi Ohno1Masakatsu Sone2Masakatsu Sone3Nobuya Inagaki4Takamasa Ichijo5Takashi Yoneda6Mika Tsuiki7Norio Wada8Kenji Oki9Kouichi Tamura10Hiroki Kobayashi11Shoichiro Izawa12Akiyo Tanabe13Mitsuhide Naruse14Mitsuhide Naruse15Department of Diabetes, Endocrinology and Nutrition, Kyoto University Graduate School of Medicine, Kyoto, JapanDepartment of Diabetes, Endocrinology and Nutrition, Kyoto University Graduate School of Medicine, Kyoto, JapanDepartment of Diabetes, Endocrinology and Nutrition, Kyoto University Graduate School of Medicine, Kyoto, JapanDivision of Metabolism and Endocrinology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, JapanDepartment of Diabetes, Endocrinology and Nutrition, Kyoto University Graduate School of Medicine, Kyoto, JapanDepartment of Diabetes and Endocrinology, Saiseikai Yokohamashi Tobu Hospital, Yokohama, JapanDepartment of Health Promotion and Medicine of the Future, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, JapanDepartment of Endocrinology and Metabolism, National Hospital Organization Kyoto Medical Center, Kyoto, JapanDepartment of Diabetes and Endocrinology, Sapporo City General Hospital, Sapporo, JapanDepartment of Molecular and Internal Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, JapanDepartment of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama, JapanDivision of Nephrology, Hypertension and Endocrinology, Nihon University School of Medicine, Tokyo, Japan0Division of Endocrinology and Metabolism, Tottori University Faculty of Medicine, Yonago, Japan1Division of Endocrinology, National Center for Global Health and Medicine, Tokyo, JapanDepartment of Endocrinology and Metabolism, National Hospital Organization Kyoto Medical Center, Kyoto, Japan2Endocrine Center, Ijinkai Takeda General Hospital, Kyoto, JapanIntroductionSome aldosterone-producing micro-adenomas cannot be detected through image inspection. Therefore, adrenal venous sampling (AVS) is often performed, even in primary aldosteronism (PA) patients who have no apparent adrenal tumors (ATs) on imaging. In most of these cases, however, the PA is bilateral.ObjectiveTo clarify the clinical need for AVS in PA patients without apparent ATs, taking into consideration the rates of adrenalectomy.MethodsThis is a retrospective cross-sectional study assessing 1586 PA patients without apparent ATs in the multicenter Japan PA study (JPAS). We analyzed which parameters could be used to distinguish unilateral PA patients without apparent ATs from bilateral patients. We also analyzed the prevalences of adrenalectomy in unilateral PA patients.ResultsThe unilateral subtype without an apparent AT was diagnosed in 200 (12.6%) of 1586 PA patients. Being young and female with a short hypertension duration, normokalemia, low creatinine level, low plasma aldosterone concentration, and low aldosterone-to-renin ratio (ARR) was significantly more common in bilateral than unilateral PA patients. If PA patients without apparent ATs were female and normokalemic with a low ARR (<560 pg/ml per ng/ml/h), the rate of unilateral PA was only 5 (1.1%) out of 444. Moreover, 77 (38.5%) of the 200 did not receive adrenalectomy, despite being diagnosed with the unilateral subtype based on AVS.ConclusionThe low prevalence of the unilateral subtype in PA patients without apparent ATs suggests AVS is not indicated for all of these patients. AVS could be skipped in female normokalemic PA patients without apparent ATs if their ARRs are not high. However, AVS should be considered for male hypokalemic PA patients with high ARRs because the rates of the unilateral subtype are high in these patients.https://www.frontiersin.org/articles/10.3389/fendo.2021.645395/fulladrenalectomyadrenal venous samplingcardiovascular diseasehyperaldosteronismprimary aldosteronism |
| spellingShingle | Kentaro Okamoto Youichi Ohno Masakatsu Sone Masakatsu Sone Nobuya Inagaki Takamasa Ichijo Takashi Yoneda Mika Tsuiki Norio Wada Kenji Oki Kouichi Tamura Hiroki Kobayashi Shoichiro Izawa Akiyo Tanabe Mitsuhide Naruse Mitsuhide Naruse Should Adrenal Venous Sampling Be Performed in PA Patients Without Apparent Adrenal Tumors? Frontiers in Endocrinology adrenalectomy adrenal venous sampling cardiovascular disease hyperaldosteronism primary aldosteronism |
| title | Should Adrenal Venous Sampling Be Performed in PA Patients Without Apparent Adrenal Tumors? |
| title_full | Should Adrenal Venous Sampling Be Performed in PA Patients Without Apparent Adrenal Tumors? |
| title_fullStr | Should Adrenal Venous Sampling Be Performed in PA Patients Without Apparent Adrenal Tumors? |
| title_full_unstemmed | Should Adrenal Venous Sampling Be Performed in PA Patients Without Apparent Adrenal Tumors? |
| title_short | Should Adrenal Venous Sampling Be Performed in PA Patients Without Apparent Adrenal Tumors? |
| title_sort | should adrenal venous sampling be performed in pa patients without apparent adrenal tumors |
| topic | adrenalectomy adrenal venous sampling cardiovascular disease hyperaldosteronism primary aldosteronism |
| url | https://www.frontiersin.org/articles/10.3389/fendo.2021.645395/full |
| work_keys_str_mv | AT kentarookamoto shouldadrenalvenoussamplingbeperformedinpapatientswithoutapparentadrenaltumors AT youichiohno shouldadrenalvenoussamplingbeperformedinpapatientswithoutapparentadrenaltumors AT masakatsusone shouldadrenalvenoussamplingbeperformedinpapatientswithoutapparentadrenaltumors AT masakatsusone shouldadrenalvenoussamplingbeperformedinpapatientswithoutapparentadrenaltumors AT nobuyainagaki shouldadrenalvenoussamplingbeperformedinpapatientswithoutapparentadrenaltumors AT takamasaichijo shouldadrenalvenoussamplingbeperformedinpapatientswithoutapparentadrenaltumors AT takashiyoneda shouldadrenalvenoussamplingbeperformedinpapatientswithoutapparentadrenaltumors AT mikatsuiki shouldadrenalvenoussamplingbeperformedinpapatientswithoutapparentadrenaltumors AT noriowada shouldadrenalvenoussamplingbeperformedinpapatientswithoutapparentadrenaltumors AT kenjioki shouldadrenalvenoussamplingbeperformedinpapatientswithoutapparentadrenaltumors AT kouichitamura shouldadrenalvenoussamplingbeperformedinpapatientswithoutapparentadrenaltumors AT hirokikobayashi shouldadrenalvenoussamplingbeperformedinpapatientswithoutapparentadrenaltumors AT shoichiroizawa shouldadrenalvenoussamplingbeperformedinpapatientswithoutapparentadrenaltumors AT akiyotanabe shouldadrenalvenoussamplingbeperformedinpapatientswithoutapparentadrenaltumors AT mitsuhidenaruse shouldadrenalvenoussamplingbeperformedinpapatientswithoutapparentadrenaltumors AT mitsuhidenaruse shouldadrenalvenoussamplingbeperformedinpapatientswithoutapparentadrenaltumors |