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Discordance between imaging and immunohistochemistry in unilateral primary aldosteronism
Author(s) -
Nanba Aya T.,
Nanba Kazutaka,
Byrd James B.,
Shields James J.,
Giordano Thomas J.,
Miller Barbara S.,
Rainey William E.,
Auchus Richard J.,
Turcu Adina F.
Publication year - 2017
Publication title -
clinical endocrinology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.055
H-Index - 147
eISSN - 1365-2265
pISSN - 0300-0664
DOI - 10.1111/cen.13442
Subject(s) - primary aldosteronism , medicine , adrenalectomy , hyperaldosteronism , aldosterone synthase , cosyntropin , aldosterone , radiology , secondary hypertension , surgery , blood pressure , adrenocorticotropic hormone , renin–angiotensin system , hormone
Summary Objective Correct subtyping of primary aldosteronism ( PA ) is essential for good surgical outcomes. Adrenal vein sampling ( AVS ) and/or computed tomography ( CT ) are used for PA subclassification. Clinical and/or biochemical improvement after surgery, however, is not always achieved in patients with presumed unilateral PA . We aimed to identify the pitfalls in PA subclassification leading to surgical treatment failures. Patients and Design We retrospectively studied 208 patients who underwent adrenal vein sampling ( AVS ) for PA subclassification in a tertiary referral centre, between January 2009 and August 2016. Simultaneous bilateral AVS was performed before and after cosyntropin administration. We implemented immunohistochemistry for aldosterone synthase ( CYP 11B2) and 17α‐hydroxylase/17,20 lyase ( CYP 17A1) in adrenal glands resected from patients without improvement of PA after surgical treatment and from those with limitations in AVS interpretation. Results Of 55 patients who underwent adrenalectomy, three (5.5%) had no improvement of PA . All three patients underwent partial adrenalectomy to remove a CT ‐detected nodule present on the same side with AVS lateralization. Immunohistochemistry revealed a CYP 11B2‐negative nodule in both cases available. All patients who underwent total adrenalectomy based on AVS lateralization benefitted from surgery, including three patients with unilateral unsuccessful AVS and aldosterone suppression in the catheterized side vs inferior vena cava. Conclusions Radiographically identified adrenal nodules are not always a source of PA , even when ipsilateral with AVS lateralization. These data caution against reliance on imaging findings, either alone or in conjunction with AVS , to guide surgery for PA .