SAT-016 The Influence of Aldosterone Values in the Tributary Veins of Unresected Adrenal Gland on Primary Aldosteronism Surgical Outcomes


In our hospital, we perform segmental adrenal venous samplings (S-AVS) to detect the exact locations of causative lesions of primary aldosteronism (PA), and adrenalectomy for localized lesion. In this study, we investigated the influence of laboratory values in the tributary veins of unresected adrenal glands to surgical outcomes. A total of 102 PA patients who underwent S-AVS (collected blood samples from 3 or more tributary veins in each adrenal gland) and unilateral adrenalectomy were analyzed. All patients were assessed on the biochemical success of Primary Aldosteronism Surgical Outcomes (PASO) one year after adrenalectomy, by performing saline infusion tests. We divided the patients into two groups; complete success (Com) and incomplete (partial and absent) success (Inc), and compared maximum aldosterone values (Ald max) and Ald max to cortisol ratio (Ald max/Cort ratio) in tributary veins of unresected side, and Ald and Ald/Cort ratio in the central veins of unresected side. Eighty-seven patients had complete biochemical success and fifteen had incomplete success. Inc group had higher Ald max (11000 [7950-22300] pg/mL vs 7030 [4260-11900] pg/mL, p < 0.05) and Ald max/Cort ratio (18.05 [12.77-34.15] vs 9.13 [6.27-14.25], p < 0.05) in the tributary veins, and Ald (9260 [5480-15100] pg/mL vs 5800 [3410-8060] pg/mL, p < 0.05) and Ald/Cort (13.67 [9.51-21.87] vs 8.08 [5.88-10.96], p < 0.05) in the central veins of unresected side, compared to Com group. In logistic analyses for PASO results as an objective variable, Ald max/Cort ratio in the tributary veins had the highest AUC (0.780) as a subjective variable. When the cutoff values were set as 20.92 or 12.77, their sensitivities / specificities were 47% / 85% and 80% / 70%, respectively. On the other hand, lateralized ratio had no significant differences between Com and Inc groups. Biochemical PASO results are influenced by aldosterone values in tributary veins or central veins of unresected side, but not lateralized ratio.

Authors: Kazuki Nakai, Yuya Tsurutani, Tomoko Takiguchi, Seishi Matsui, Kohzoh Makita, Jun Inoue, Maki Nagata, Noriko Makita, Masaomi Nangaku, Jun Saito, Masao Omura, Tetsuo Nishikawa
Keywords: segmental adrenal venous sampling, S-AVS, tributary veins
DOI Number: 10.1210/js.2019-SAT-016      Publication Year: 2019

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