SFEBES2022 Oral Poster Presentations Adrenal and Cardiovascular (4 abstracts)
Complete clinical cure of primary aldosteronism (PA) is predictable and sustained for at least two years
Emily Goodchild 1,2 , Xilin Wu 1,4 , Russell Senanayake 3,4 , Waiel Bashari 3,4 , Jackie Salsbury 1,4 , Claudia Cabrera 1 , Giulia Argentesi 1,4 , Samuel O’Toole 1,4 , James MacFarlane 3 , Kate Laycock 1,4 , Daniela Benu 1,4 , Matthew Matson 2 , Brendan Koo 3 , Laila Parvanta 2 , Nick Hilliard 3 , Vasilis Kosmoliaptsis 3 , Alison Marker 4 , Daniel Berney 2 , Wilson Tan 5 , Roger Foo 5 , Charles Mein 1 , Eva Wozniak 1 , Emmanuel Savage 1 , Anju Sahdev 2 , Nicholas Bird 4 , Istvan Boros 3 , Stefan Hader 3 , Victoria Warnes 4 , Dan Gillett 4 , Anne Dawnay 2 , Elizabeth Adeyeye 6 , Alessandro Prete 7 , Angela Taylor 7 , Arlt Wiebke 7 , Anish Bhuva 2 , Franklin Aigbirhio 3 , Charlotte Manisty 2 , Kennedy Cruickshank 6,4 , Heok Cheow 4 , Mark Gurnell 3,4 , William Drake 2,1 & Morris Brown 1,4
1Queen Mary University London, London, United Kingdom; 2Saint Bartholomew’s Hospital, London, United Kingdom; 3Cambridge University, Cambridge, United Kingdom; 4Addenbrooke’s Hospital, Cambridge, United Kingdom; 5National University of Singapore, Singapore, Singapore; 6Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom; 7University of Birmingham, Birmingham, United Kingdom; 8King’s College London, London, United Kingdom
Introduction: In a prospective within-patient study (MATCH) 11C-metomidate PET-CT (MTO) was an accurate non-invasive alternative to adrenal vein sampling in the detection of unilateral PA1. Post-adrenalectomy (ADX), 24/78 (30%) patients achieved complete clinical success (PASO consensus) at 6 months, but 75% achieved reduction in B-type natriuretic peptide (BNP).
Aim: To determine: 1. the number of patients who sustain complete clinical success, and reduction in BNP, at 2 years, 2. whether tumour genotype associates with likelihood of sustained cure, and can be predicted from the baseline urinary 18-OH cortisol/cortisol (‘hybrid steroid’) ratio.
Results: 63/78 ADX patients have completed 2-year follow-up. 20 of the 24 patients (83%) with complete clinical success at 6 months continue to have an average home BP <135/85mmHg, off treatment, at 2 years. In 18/78 patients, the aldosterone-producing-adenoma had a KCNJ5 (K+-channel) mutation; 14 achieved complete clinical success at both 6 and 24 months. Two patients with a double-mutation of CTNNB1/GNAQ also showed complete clinical success at 6 and 24 months. By contrast, 20/78 ADX patients had a CACNA1D (Ca++-channel) mutation, of whom 3 and 1 patients, respectively, were clinically cured at 6 and 24 months. The hybrid steroid ratio at baseline, measured in 66/78 patients, separated patients with KCNJ5 mutations (6.4(
Conclusion: Complete cure of hypertension, achieved in a minority of ADX patients, is likely to be sustained for at least 2 years. Most complete cures are of patients with a KCNJ5 mutation, who are potentially predicted by their urine hybrid-steroid ratio. The majority of ADX patients have a substantial reduction in BNP, indicating the benefits, beyond cure of hypertension, of suppressing autonomous aldosterone production.
Reference 1. Wu et al. DOI:10.21203/rs.3.rs-1179128/v1.2021.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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