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

Ohno, Youichi; Naruse, Mitsuhide; Beuschlein, Felix; Schreiner, Florentine; Parasiliti-Caprino, Mirko; Deinum, Jaap; Drake, William M.; Fallo, Francesco; Fuss, Carmina T.; Grytaas, Marianne A.; Ichijo, Takamasa; Inagaki, Nobuya; Kakutani, Miki; Kastelan, Darko; Kraljevic, Ivana; Katabami, Takuyuki; Kocjan, Tomaz; Monticone, Silvia; Mulatero, Paolo; O'Toole, Sam; Kobayashi, Hiroki; Sone, Masakatsu; Tsuiki, Mika; Wada, Norio; Williams, Tracy Ann; Reincke, Martin und Tanabe, Akiyo (2021): Adrenal Venous Sampling-Guided Adrenalectomy Rates in Primary Aldosteronism: Results of an International Cohort (AVSTAT). In: Journal of Clinical Endocrinology & Metabolism, Bd. 106, Nr. 3, E1400-E1407

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.

• Dokumententyp: Zeitschriftenartikel
• Fakultät: Medizin
• Themengebiete: 600 Technik, Medizin, angewandte Wissenschaften > 610 Medizin und Gesundheit
• ISSN: 0021-972X
• Sprache: Englisch