Correlation Between Lateralization Index of Adrenal Venous Sampling and Standardized Outcome in Primary Aldosteronism
OBJECTIVES: The aim of this study was to investigate the impact of adrenal venous sampling (AVS) lateralization cutoffs on surgical outcomes. PATIENTS AND METHODS: Cosyntropin-stimulated AVS was used to guide surgical management of 377 patients with primary aldosteronism (PA) who were evaluated 6 mo...
Autores principales: | , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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Endocrine Society
2018
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6057509/ https://www.ncbi.nlm.nih.gov/pubmed/30057970 http://dx.doi.org/10.1210/js.2018-00055 |
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author | Umakoshi, Hironobu Tsuiki, Mika Yokomoto-Umakoshi, Maki Takeda, Yoshiyu Takashi, Yoneda Kurihara, Isao Itoh, Hiroshi Katabami, Takuyuki Ichijo, Takamasa Wada, Norio Shibayama, Yui Yoshimoto, Takanobu Ashida, Kenji Ogawa, Yoshihiro Kawashima, Junji Sone, Masakatsu Inagaki, Nobuya Takahashi, Katsutoshi Watanabe, Minemori Matsuda, Yuichi Kobayashi, Hiroki Shibata, Hirotaka Kamemura, Kohei Otsuki, Michio Fujii, Yuichi Yamamto, Koichi Ogo, Atsushi Okamura, Shintaro Miyauchi, Shozo Fukuoka, Tomikazu Izawa, Shoichiro Yanase, Toshihiko Hashimoto, Shigeatsu Yamada, Masanobu Yoshikawa, Yuichiro Kai, Tatsuya Suzuki, Tomoko Kawamura, Takashi Naruse, Mitsuhide |
author_facet | Umakoshi, Hironobu Tsuiki, Mika Yokomoto-Umakoshi, Maki Takeda, Yoshiyu Takashi, Yoneda Kurihara, Isao Itoh, Hiroshi Katabami, Takuyuki Ichijo, Takamasa Wada, Norio Shibayama, Yui Yoshimoto, Takanobu Ashida, Kenji Ogawa, Yoshihiro Kawashima, Junji Sone, Masakatsu Inagaki, Nobuya Takahashi, Katsutoshi Watanabe, Minemori Matsuda, Yuichi Kobayashi, Hiroki Shibata, Hirotaka Kamemura, Kohei Otsuki, Michio Fujii, Yuichi Yamamto, Koichi Ogo, Atsushi Okamura, Shintaro Miyauchi, Shozo Fukuoka, Tomikazu Izawa, Shoichiro Yanase, Toshihiko Hashimoto, Shigeatsu Yamada, Masanobu Yoshikawa, Yuichiro Kai, Tatsuya Suzuki, Tomoko Kawamura, Takashi Naruse, Mitsuhide |
author_sort | Umakoshi, Hironobu |
collection | PubMed |
description | OBJECTIVES: The aim of this study was to investigate the impact of adrenal venous sampling (AVS) lateralization cutoffs on surgical outcomes. PATIENTS AND METHODS: Cosyntropin-stimulated AVS was used to guide surgical management of 377 patients with primary aldosteronism (PA) who were evaluated 6 months after surgery. MAIN OUTCOME MEASURES: The proportion of patients that achieved clinical benefit and complete biochemical success based on the AVS aldosterone lateralization index (LI) was determined. RESULTS: Clinical benefit was achieved in 29 of 47 patients with an LI between 2 and 4, in 66 of 101 with an LI between 4 and 10, and in 158 of 203 with an LI > 10 (P < 0.01 for trend). Complete biochemical success was achieved in 27 of 42 with an LI between 2 and 4, in 60 of 76 with an LI between 4 and 10, and in 127 of 155 with an LI > 10 (P = 0.024 for trend). After adjustment for confounders and using those patients with an LI between 2 and 4 as a reference, a clinical benefit was associated only with those with an LI > 10 (OR, 2.30; 95% CI, 1.03 to 5.16), whereas complete biochemical success was associated with those with an LI between 4 and 10 (OR, 2.83; 95% CI, 1.14 to 7.01) or LI > 10 (OR, 3.55; 95% CI, 1.47 to 8.55). CONCLUSIONS: Difference of clinical outcome was relatively small when strict LI diagnostic threshold was used; biochemical cure was sufficiently achieved when an LI > 4 was used. Our study by standardized outcome measures validated that an LI > 4 may be appropriate for determining unilateral disease in PA. |
format | Online Article Text |
id | pubmed-6057509 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2018 |
publisher | Endocrine Society |
record_format | MEDLINE/PubMed |
spelling | pubmed-60575092018-07-27 Correlation Between Lateralization Index of Adrenal Venous Sampling and Standardized Outcome in Primary Aldosteronism Umakoshi, Hironobu Tsuiki, Mika Yokomoto-Umakoshi, Maki Takeda, Yoshiyu Takashi, Yoneda Kurihara, Isao Itoh, Hiroshi Katabami, Takuyuki Ichijo, Takamasa Wada, Norio Shibayama, Yui Yoshimoto, Takanobu Ashida, Kenji Ogawa, Yoshihiro Kawashima, Junji Sone, Masakatsu Inagaki, Nobuya Takahashi, Katsutoshi Watanabe, Minemori Matsuda, Yuichi Kobayashi, Hiroki Shibata, Hirotaka Kamemura, Kohei Otsuki, Michio Fujii, Yuichi Yamamto, Koichi Ogo, Atsushi Okamura, Shintaro Miyauchi, Shozo Fukuoka, Tomikazu Izawa, Shoichiro Yanase, Toshihiko Hashimoto, Shigeatsu Yamada, Masanobu Yoshikawa, Yuichiro Kai, Tatsuya Suzuki, Tomoko Kawamura, Takashi Naruse, Mitsuhide J Endocr Soc Clinical Research Articles OBJECTIVES: The aim of this study was to investigate the impact of adrenal venous sampling (AVS) lateralization cutoffs on surgical outcomes. PATIENTS AND METHODS: Cosyntropin-stimulated AVS was used to guide surgical management of 377 patients with primary aldosteronism (PA) who were evaluated 6 months after surgery. MAIN OUTCOME MEASURES: The proportion of patients that achieved clinical benefit and complete biochemical success based on the AVS aldosterone lateralization index (LI) was determined. RESULTS: Clinical benefit was achieved in 29 of 47 patients with an LI between 2 and 4, in 66 of 101 with an LI between 4 and 10, and in 158 of 203 with an LI > 10 (P < 0.01 for trend). Complete biochemical success was achieved in 27 of 42 with an LI between 2 and 4, in 60 of 76 with an LI between 4 and 10, and in 127 of 155 with an LI > 10 (P = 0.024 for trend). After adjustment for confounders and using those patients with an LI between 2 and 4 as a reference, a clinical benefit was associated only with those with an LI > 10 (OR, 2.30; 95% CI, 1.03 to 5.16), whereas complete biochemical success was associated with those with an LI between 4 and 10 (OR, 2.83; 95% CI, 1.14 to 7.01) or LI > 10 (OR, 3.55; 95% CI, 1.47 to 8.55). CONCLUSIONS: Difference of clinical outcome was relatively small when strict LI diagnostic threshold was used; biochemical cure was sufficiently achieved when an LI > 4 was used. Our study by standardized outcome measures validated that an LI > 4 may be appropriate for determining unilateral disease in PA. Endocrine Society 2018-05-24 /pmc/articles/PMC6057509/ /pubmed/30057970 http://dx.doi.org/10.1210/js.2018-00055 Text en Copyright © 2018 Endocrine Society https://creativecommons.org/licenses/by-nc-nd/4.0/ This article has been published under the terms of the Creative Commons Attribution Non-Commercial, No-Derivatives License (CC BY-NC-ND; https://creativecommons.org/licenses/by-nc-nd/4.0/). |
spellingShingle | Clinical Research Articles Umakoshi, Hironobu Tsuiki, Mika Yokomoto-Umakoshi, Maki Takeda, Yoshiyu Takashi, Yoneda Kurihara, Isao Itoh, Hiroshi Katabami, Takuyuki Ichijo, Takamasa Wada, Norio Shibayama, Yui Yoshimoto, Takanobu Ashida, Kenji Ogawa, Yoshihiro Kawashima, Junji Sone, Masakatsu Inagaki, Nobuya Takahashi, Katsutoshi Watanabe, Minemori Matsuda, Yuichi Kobayashi, Hiroki Shibata, Hirotaka Kamemura, Kohei Otsuki, Michio Fujii, Yuichi Yamamto, Koichi Ogo, Atsushi Okamura, Shintaro Miyauchi, Shozo Fukuoka, Tomikazu Izawa, Shoichiro Yanase, Toshihiko Hashimoto, Shigeatsu Yamada, Masanobu Yoshikawa, Yuichiro Kai, Tatsuya Suzuki, Tomoko Kawamura, Takashi Naruse, Mitsuhide Correlation Between Lateralization Index of Adrenal Venous Sampling and Standardized Outcome in Primary Aldosteronism |
title | Correlation Between Lateralization Index of Adrenal Venous Sampling and Standardized Outcome in Primary Aldosteronism |
title_full | Correlation Between Lateralization Index of Adrenal Venous Sampling and Standardized Outcome in Primary Aldosteronism |
title_fullStr | Correlation Between Lateralization Index of Adrenal Venous Sampling and Standardized Outcome in Primary Aldosteronism |
title_full_unstemmed | Correlation Between Lateralization Index of Adrenal Venous Sampling and Standardized Outcome in Primary Aldosteronism |
title_short | Correlation Between Lateralization Index of Adrenal Venous Sampling and Standardized Outcome in Primary Aldosteronism |
title_sort | correlation between lateralization index of adrenal venous sampling and standardized outcome in primary aldosteronism |
topic | Clinical Research Articles |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6057509/ https://www.ncbi.nlm.nih.gov/pubmed/30057970 http://dx.doi.org/10.1210/js.2018-00055 |
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