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...

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Autores principales: 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
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Endocrine Society 2018
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.
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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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