| Author/Editor | Ohno, Youichi; Naruse, Mitsuhide; Beuschlein, Felix; Schreiner, Florentine; Parasiliti-Caprino, Mirko Parasiliti-Caprino; Deinum, Jaap; Drake, William M; Fallo, Francesco; Fuss, Carmina T; Kocjan, Tomaž | |
| Title | Adrenal venous sampling-guided adrenalectomy rates in primary aldosteronism | |
| Type | članek | |
| Vol. and No. | Letnik 106, št. 3 | |
| Publication year | 2021 | |
| Volume | str. e1400-e1407 | |
| ISSN | 1945-7197 - The journal of clinical endocrinology & metabolism | |
| Language | eng | |
| 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. | |
| Keywords | primary aldosteronism adrenalectomy adrenal venous sampling primarni aldosteronizem adrenalektomija vzorčenje nadledvičnih ven |