Indices of ACTH‐stimulated adrenal venous sampling as predictors of postsurgical outcomes in primary aldosteronism. (13th October 2021)

• Record Type: Journal Article
• Authors: Lee, Seung Hun; Kim, Jong Woo; Yoon, Hyun‐Ki; Kim, Sang Wan; Kim, Su Jin; Lee, Kyu Eun; Lee, Yu‐Mi; Sung, Tae‐Yon; Hong, Suck Joon; Shin, Chan Soo; Koh, Jung‐Min; Kim, Jung Hee
• Is Part Of: Clinical endocrinology. Volume 96:Number 4(2022)
• Page Start: 521
• Page End: 530
• Publication Date: 2021-10-13
• Subjects: adrenal -- adrenal venous sampling -- aldosterone -- primary aldosteronism; Endocrinology -- Periodicals; 616.4005
• DOI: 10.1111/cen.14610
• Languages: English
• ISSNs: 0300-0664

Abstract

Abstract: Objective: This study aimed to investigate the impact of indices of adrenal venous sampling (AVS) on postsurgical outcomes in patients with primary aldosteronism (PA). Design and Patients: This retrospective study determined biochemical and clinical outcomes based on ACTH‐stimulated AVS parameters (lateralisation index [LI], contralateral ratio [CLR], and ipsilateral ratio [ILR]) in 251 patients with PA at 3 months after surgery. Results: Modified complete biochemical success was achieved in 8 of 12 (66.7%) patients with LI = 3–4, 39 of 47 (83.0%) with LI = 4–10, and 155 of 169 (91.7%) with LI ≥ 10 ( p = .004 for trend). Modified complete biochemical success was achieved in 29 of 38 (76.3%) patients with CLR ≥ 1 and ILR ≤ 2, 73 of 86 (84.9%) with CLR = 0.25–1 and ILR > 2, and 100 of 104 (96.2%) with CLR < 0.25 and ILR > 2 ( p = .001 for trend). After adjusting for confounders, modified complete biochemical success was associated with an LI ≥ 10 (odds ratio [OR] = 6.32; 95% confidence interval [CI] = 1.33–29.93) using LI = 3–4 as a reference and combined CLR < 0.25 and ILR > 2 (OR = 11.49; 95% confidence interval [CI] = 2.49–53.01) using combined CLR ≥ 1 and ILR ≤ 2 as a reference. Using combined CLR ≥ 1 and ILR ≤ 2 as a reference, complete clinical success was associated with combined CLR < 0.25 and ILR > 2 (OR = 3.10; 95% CI = 1.03–9.28) and combined CLR = 0.25–1 and ILR > 2 (OR = 4.92; 95% CI = 1.64–14.76). Conclusion: LI ≥ 10 may be appropriate for achieving biochemical success. With ILR > 2, CLR < 0.25, and CLR < 1 may be appropriate for achieving biochemical and clinical success, respectively.