ECE2018 Poster Presentations: Adrenal and Neuroendocrine Tumours Adrenal cortex (to include Cushing's) (70 abstracts)
Is the adrenal vein sampling the gold standard diagnostic test for the subtyping of primary aldosteronism?
Ana Jiménez Portilla 1 , Elena Mena Ribas 1 , Antonia Barceló Bennasar 2 , Juan Manuel Martínez Ruitort 3 , Cristina Álvarez Segurola 4 , Mercedes Noval Font 1 , Carlos Antich Barceló 1 , Guillermo Serra Soler 1 , Iñaki Argüelles Jiménez 1 , Santiago Tofé Povedano 1 & Vicente Pereg Macazaga 1
1Endocrinology Department. Universitary Hospital Son Espases, Palma de Mallorca, Spain; 2Clinical Analysis Department, Palma de Mallorca, Spain; 3Radiology Department, Palma de Mallorca, Spain; 4General Surgery Department, Palma de Mallorca, Spain.
Introduction: Primary aldosteronism (PA) is the most common cause of secondary hypertension (5–10%) and it is underdiagnosed. Less than 50% of patients with PA have hypokalemia. The tests for determinate subtype of PA are cross-sectional imaging (adrenal CT or MRI) and adrenal vein sampling (AVS). The AVS seems to be important to direct appropriate therapy and surgery is the preferred treatment for patients with unilateral disease.
Material and methods: We reviewed 29 patients with PA confirmed by saline infusión test (SIT) who underwent AVS. We described the baseline characteristics and the results of the AVS. We analyzed the concordance between imaging and AVS.
Results: Our study included 24 men (82.8%) and five women (17.2%) with a median age of 59.5 years (39–76). The median age of diagnosis of hypertension was 43 years (25–57) and the time passed until the diagnosis of PA was 13 years (1–26). The median body max index was 30.81 (21.44–47.80). Twenty-three patients had family history of hypertension (79.3%). The median value of blood pressure was: systolic 150 mmHg (130–192) and diastolic 90 mmHg (74–111). Twenty-three patients were treated with 3 or more antihypertensive drugs (79.3%). Twenty-six patients had hypokalemia (89.7%), with a median potassium of 2.9 mEq/L (2.4–3.9) and a median MDRD of 88.3 (47.1–106.2). 40% of patients had hypertensive retinopathy (8 of 20 patients examined) and 70.4% had left ventricular hypertrophy (19 of 27 patients examined). Cross-sectional imaging was normal in 10 patients (34.5%) and abnormal in 19 (65.5%): unilateral mass in 16 and bilateral masses in 3. AVS was lateralizing in 19 patients (65.5%), non-lateralizing in 5 (17.2%), indeterminate in 2 (6.9%) and technical AVS failure in 3 (10.3%). Imaging and AVS were concordant in 61.5% of patients. All patients who underwent surgery (adrenalectomy) normalized potassium (n=15). After follow up, 20% of patients were completely cured (normotensive without antihypertensive drugs) and 80% demonstrated improvement (better blood pressure control or decrease in number of antihypertensive drugs).
Conclusions: The high percentage of hypokalemia suggests that PA is underdiagnosed in our area. The clinical suspicion is important because these patients have a much higher cardiovascular risk profile than patients with essential hypertension, and it is demonstrated by the high prevalence of left ventricular hypertrophy. Due to the poor performance of cross-sectional imaging, it is indicated to perform AVS as a better test for determination of PA subtype and decide the appropriate treatment.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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