Contralateral Suppression in Adrenal Venous Sampling Predicts Clinical and Biochemical Outcome in Primary Aldosteronism
An erratum to this article was published (J Clin Endocrinol Metab, 18 Dec 2024 ↗)
Authors' conclusion
A CS >50% was an independent predictor of complete clinical and biochemical cure. Moreover, it can predict unilateral primary aldosteronism and postoperative biochemical hypoaldosteronism. Our findings underscore the usefulness of CS for clinical decision-making.
Study context
- Population
- Patients with PA undergoing adrenal venous sampling (AVS) under cosyntropin infusion150 AVS
- Participants
- 150 patients
- Exposure
- Contralateral suppression (CS) >50% vs CS ≤50% on AVS
- Outcome
- Impact of AVS hormone parameters on lateralization and on complete biochemical and clinical outcomes
Methodological detailscosyntropin-stimulated AVS, sequential
- Cosyntropin-stimulated AVS
- Sequential
Main finding
As reported in the abstract
CS >50% vs CS ≤50%Odds ratio (95% CI)P value
Complete biochemical cure, multivariable
125(11.904–5000)
P = 0.001Hypertension remission, multivariable
12.19(2.074–250)
P = 0.023- More frequent with CS >50%
- complete biochemical cure 98.41% vs 42.86%; P < 0.001
- More frequent with CS >50%
- complete clinical cure 41.94% vs 0%; P < 0.001
Observational data: associations, not effects.
Further findings
Prediction of lateralization
- Nondominant RASI <0.5 (CS >50%) for contralateral lateralization: sensitivity/specificity
- 86.84% / 92.96%
- A/C in dominant adrenal vein (AV) >5.9 for ipsilateral lateralization: sensitivity/specificity
- 74.67% / 80%
- Dominant RASI >4.7 for ipsilateral lateralization: sensitivity/specificity
- 35.21% / 88.06%
Correlates of CS
- CS correlated with high aldosterone at diagnosis
- P < 0.001
- CS correlated with low postoperative aldosterone at 1 month
- P = 0.019
Safety
| Outcome | Estimate | P value |
|---|---|---|
| Postoperative biochemical hypoaldosteronismMore frequent with CS >50% | 70% vs 16.67% | P = 0.014 |
Original publication
Contralateral Suppression in Adrenal Venous Sampling Predicts Clinical and Biochemical Outcome in Primary Aldosteronism. J Clin Endocrinol Metab. Published 5 March 2024. doi:10.
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