S. Cartwright1, J. Shank1, A. Kotwal2, W. Goldner2, A. Patel2, A. Fingeret1 1University of Nebraska Medical Center, Department Of Surgery, Omaha, NE, USA 2University of Nebraska Medical Center, Department Of Internal Medicine, Omaha, NE, USA
Background:
Adrenal venous sampling (AVS) is used to distinguish unilateral from bilateral aldosterone hypersecretion as a cause of primary hyperaldosteronism (PHA). This distinction is critical because unilateral disease is usually treated with adrenalectomy and bilateral hypersecretion managed medically.
Methods:
We performed a retrospective cohort study of adult patients undergoing index adrenalectomy for PHA at a single institution from July of 2013 to June of 2022. Clinical and pathologic variables were assessed including patient age at surgery, sex, race or ethnicity, body mass index, blood pressure, number and type of antihypertensive medications pre- and post-operatively, potassium level and supplementation, plasma aldosterone concentration, plasma renin activity, imaging findings, AVS results and concordance of imaging findings with AVS. Statistical analysis was performed with Mann Whitney U and chi-squared Fisher’s exact tests.
Results:
In our cohort, 21 patients underwent AVS and adrenalectomy for PHA. Of these, two patients did not have imaging findings and 19 were image-localized. For patients with image-localization AVS was concordant in nine, discordant in four, and nondiagnostic in six patients after at least two attempts: one patient with aberrant anatomy and five patients with aldosterone suppression contralateral to their image-localized lesion (Figure 1). For patients with discordant findings, the age range was 35.8 to 72.4 years compared with concordant patient age range of 49.8 to 71.7 years. The overall discordance between imaging results and AVS was 40%. The only significant difference between patients with concordant and discordant results was the aldosterone level with concordant patients having a mean of 58 ng/dL compared with discordant patients 23 ng/dL (p = 0.002). After adrenalectomy, there was a significant reduction in antihypertensive medications for the entire cohort from a median of 3 medications (IQR 2-4) to 1 medication (IQR 1-2), p < 0.001.
Conclusions:
In this cohort, 40% of patients with selective AVS had discordant imaging and AVS results. Preoperative aldosterone level was positively associated with concordance, with higher PAC more likely to have imaging and AVS concordance. Overall, hypertension was significantly improved following adrenalectomy for PHA with a median decrease of 2 antihypertensives. Our results support recommendations to perform AVS on all candidates for adrenalectomy for PHA.
