ECE2018 Guided Posters Adrenal clinical (10 abstracts)
Segmental adrenal venous sampling may give a key to solution about the debate of cosyntropin stimulation or not
Fumitoshi Satoh 1, , Yuta Tezuka 1, , Ryo Morimoto 2 , Kei Omata 1, , Yoshikiyo Ono 2 , Yasuhiro Igarashi 2 , Masataka Kudo 2 , Kei Takase 3 & Sadayoshi Ito 2
1Division of Clinical Hypertension, Endocrinology and Metabolism, Tohoku University Graduate School of Medicine, Sendai, Japan; 2Division of Nephrology, Endocrinology and Vasucular Medicine, Tohoku University Hospital, Sendai, Japan; 3Department of Radiology, Tohoku University Hospital, Sendai, Japan.
Background: Adrenal venous sampling (AVS) is critical to differentiate unilateral primary aldosteronism (PA) subtype. However, there are large discrepancies between institutions in the diagnostic criteria of AVS. Especially, the most major debate is in whether cosyntropin stimulation should be used for localization diagnosis or not. Segmental AVS (S-AVS) is a refinement of central AVS (C-AVS) in which samples are taken from the tributaries of the central adrenal veins allowing the identification of the intra-adrenal aldosterone secretion in far more precise fashion.
Objective: To examine C-AVS data before and after cosyntropin by those of S-AVS.
Methods: The results of both C-AVS and S-AVS procedures in all 248 cases (133 APA and 115 BHA) performed in our institution were interpreted with diagnostic criteria of lateralized index (LI) by C-AVS. All of the APA cases underwent unilateral laparoscopic adrenalectomy based on the S-AVS findings, and were reconfirmed by pathologically and by postoperative clinical characteristics.
Results: If surgery-indicated LI of C-AVS before cosyntropin (pre-LI) were ≥3, the right dominant were 109 cases (62 right APA (56.9%) and 2 left APA) and 45 BHA cases (41.3%)), and the left dominant were 52 cases (48 left APA (92.3%) and 4 BHA cases (7.7%)). All of 66 PA cases with pre-LI <3 were diagnosed as BHA by S-AVS. The cases with LI of C-AVS after cosyntropin (post-LI) ≥ 4 were all 104 APA cases, and the cases with post-LI <4 of C-AVS were 144 cases (29 APA cases (20.0%) and 115 BHA cases (80.0%)) diagnosed by S-AVS. ROC analysis of unilateral versus bilateral judged by S-AVS could give us the most suitable pre-LI and post-LI cutoff values of C-AVS for localization diagnosis of aldosteronism.
Conclusions: S-AVS data gave us the more precise localization of hyperaldosteronism as compared to C-AVS data. If we use pre-LI of C-AVS for surgery-indication, we should be very careful about the high prevalence of BHA in right dominant cases. If we use post-LI ≥ 4 of C-AVS, we should also consider the possibility of overlooking at surgery-adaptive APA cases in the cases with post-LI <4.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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