Application of strict criteria in adrenal venous sampling increases the proportion of missed patients with unilateral disease who benefit from surgery for primary aldosteronism

Journal of Hypertension
G A KlineJ L Pasieka

Abstract

Adrenal vein sampling (AVS) is intended to confirm unilateral forms of primary aldosteronism, which are amenable to surgical cure. Excessively strict AVS criteria to define lateralization may result in many patients incorrectly categorized as bilateral primary aldosteronism and opportunity for surgical cure missed. Retrospective review of an AVS-primary aldosteronism database in which surgical cases are verified by standardized outcomes. Having used 'less strict' AVS criteria for lateralization, we examined the distribution of AVS lateralization indices in our confirmed unilateral primary aldosteronism cases both with and without cosyntropin stimulation. The proportion of proven unilateral cases that would have been missed with stricter AVS interpretation criteria was calculated. Particular focus was given to the proportion of missed cases according to use of international guidelines. False-positive lateralization with 'less strict' interpretation was also calculated. Of 80 surgical primary aldosteronism cases, 10-23% would have been missed with AVS lateralization indices of 3 : 1 to 5 : 1, with or without cosyntropin. If strict selectivity indices (for confirmation of catheterization) were combined with strict lateralization i...Continue Reading

References

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Citations

Dec 28, 2018·The Journal of Clinical Endocrinology and Metabolism·Davis SamAlexander A Leung
Nov 2, 2019·Journal of Medicine and Life·Viktor O ShidlovskyiYuryi M Futuima
Dec 19, 2019·Journal of Hypertension·Troy H PuarPeng C Kek
Nov 13, 2020·The Journal of Clinical Endocrinology and Metabolism·Davis SamAlexander A Leung
May 20, 2020·The Canadian Journal of Cardiology·Davis SamAlexander A Leung
Oct 28, 2019·Endocrinology and Metabolism Clinics of North America·Gregory L Hundemer, Anand Vaidya
Dec 28, 2021·American Journal of Hypertension·D SamA A Leung

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