z-logo
open-access-imgOpen Access
Basal contralateral aldosterone suppression is rare in lateralized primary aldosteronism
Author(s) -
Marie-Josée Desrochers,
Matthieu St-Jean,
Nada El Ghorayeb,
Isabelle Bourdeau,
Benny So,
Éric Thérasse,
Gregory Kline,
André Lacroix
Publication year - 2020
Publication title -
european journal of endocrinology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.897
H-Index - 148
eISSN - 1479-683X
pISSN - 0804-4643
DOI - 10.1530/eje-20-0254
Subject(s) - aldosterone , primary aldosteronism , basal (medicine) , medicine , endocrinology , urology , gastroenterology , insulin
Context: Unilateral aldosteronomas should suppress renin and contralateral aldosterone secretion. Complete aldosterone suppression in contralateral adrenal vein sample (AVS) could predict surgical outcomes. Objectives: To retrospectively evaluate the prevalence of basal contralateral suppression using Aldosterone (A) contralateral(CL) /A peripheral(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 clinical and biochemical surgical cure. To compare the accuracy of A CL /A P to the basal and post-ACTH lateralization index (LI) in predicting surgical cure. Methods: In total, 330 patients with PA and successful AVS were included; 124 lateralizing patients underwent surgery. Clinical and biochemical cure at 3 and 12 months were evaluated using the PASO criteria. Results: Using A CL /A P and (A/C) CL /(A/C) P at the cut-off of 1, the prevalence of contralateral suppression was 6 and 45%, respectively. Using ROC curves, the A CL /A P 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 A CL /A P offering the best sensitivity (Se) and specificity (Sp) for clinical and biochemical 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-ACTH 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 A CL /A P is rare and incomplete compared to the (A/C) CL /(A/C) P ratio and is associated with clinical and biochemical postoperative outcome, but with modest accuracy.

The content you want is available to Zendy users.

Already have an account? Click here to sign in.
Having issues? You can contact us here