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- Title
Basal contralateral aldosterone suppression is rare in lateralized primary aldosteronism.
- Authors
Desrochers, Marie-Josée; St-Jean, Matthieu; El Ghorayeb, Nada; Bourdeau, Isabelle; So, Benny; Therasse, Éric; Kline, Gregory; Lacroix, André
- Abstract
Context: Unilateral aldosteronomas should suppress renin and contralate ral aldosterone secretion. Complete aldosterone suppression in contralateral adrenal vein sample (A VS) could predict surgical outcomes. Objectives: To retrospectively evaluate the prevalence of basal contralate ral suppression using Aldosterone (A)contralateral(CL)/Aperipheral(P) as compared to (A/Cortisol(C)CL)/(A/C)P ratio in primary aldosteronism (PA) patients studied in two Canadian centers. To determine the best cut-off to predict c linical and biochemical surgical cure. To compare the accuracy of ACL/AP to the basal and post-ACTH lateralization index (LI) in predic ting surgical cure. Methods: In total, 330 patients with PA and successful AVS were include d; 124 lateralizing patients underwent surgery. Clinical and biochemical cure at 3 and 12 months were evaluated using the PASO criteria. Results: Using ACL/AP and (A/C)CL/(A/C)P at the cut-off of 1, the prevalence of contralateral suppressio n was 6 and 45%, respectively. Using ROC curves, the ACL/AP ratio is associated with clinical cure at 3 and 12 months and biochemical cure at 12 months. (A/C)CL/(A/C)P is associated with biochemical cure only. The cut-offs for ACL/AP offering the best sensitivity (Se) and specificity (Sp) for clinical and biochemic al cures at 12 months are 2.15 (Se: 63% and Sp: 71%) and 6.15 (Se: 84% and Sp: 77%), respectively. Basal LI and post-ACT H LI are associated with clinical cure but only the post- ACTH LI is associated with biochemical cure. Conclusions: In lateralized PA, basal contralateral suppression defined by ACL/AP is rare and incomplete compared to the (A/C)CL/(A/C)P ratio and is associated with clinical and biochemical postoper ative outcome, but with modest accuracy.
- Subjects
HYPERALDOSTERONISM; RECEIVER operating characteristic curves; ADRENOCORTICOTROPIC hormone
- Publication
European Journal of Endocrinology, 2020, Vol 183, Issue 4, p399
- ISSN
0804-4643
- Publication type
Article
- DOI
10.1530/EJE-20-0254