Subtyping of Primary Aldosteronism in the AVIS-2 Study: Assessment of Selectivity and Lateralization

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  • Giacomo Rossitto
    Department of Medicine-DIMED, University Hospital, Padova, Italy
  • Laurence Amar
    Hypertension unit, Université de Paris, Inserm UMR970 and CIC1418, Hôpital Européen Georges Pompidou, Paris, France
  • Michel Azizi
    Hypertension unit, Université de Paris, Inserm UMR970 and CIC1418, Hôpital Européen Georges Pompidou, Paris, France
  • Anna Riester
    Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, LMU München, München, Germany
  • Martin Reincke
    Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, LMU München, München, Germany
  • Christoph Degenhart
    Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, LMU München, München, Germany
  • Jiri Widimsky
    3rd Department of Medicine, Charles University Prague, General Hospital, Prague, Czech Republic
  • Mitsuhide Naruse
    Department of Endocrinology, Clinical Research Institute, NHO Kyoto Medical Center and Endocrine Center, Ijinkai Takeda General Hospital, Kyoto, Japan
  • Jaap Deinum
    Departments of Internal Medicine and Radiology, Radboud University Nijmegen, Nijmegen, The Netherlands
  • Leo Schultzekool
    Departments of Internal Medicine and Radiology, Radboud University Nijmegen, Nijmegen, The Netherlands
  • Tomaz Kocjan
    Department of Endocrinology, Diabetes and Metabolic Diseases, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
  • Aurelio Negro
    Department of Internal Medicine, Azienda Unità Sanitaria Locale, IRCCS Arcispedale S. Maria Nuova, Reggio Emilia, Italy
  • Ermanno Rossi
    Department of Internal Medicine, Azienda Unità Sanitaria Locale, IRCCS Arcispedale S. Maria Nuova, Reggio Emilia, Italy
  • Gregory Kline
    University of Calgary, Foothills Medical Centre, Calgary, Canada
  • Akiyo Tanabe
    Department of Diabetes, Endocrinology and Metabolism, National Center for Global Health and Medicine (NCGHM), Tokyo, Japan
  • Fumitoshi Satoh
    Department of Nephrology, Tohoku University Hospital, Endocrinology and Vascular Medicine, Sendai, Japan
  • Lars Christian Rump
    Department of Nephrology, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
  • Oliver Vonend
    Department of Nephrology, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
  • Holger S Willenberg
    Division of Endocrinology and Metabolism, Rostock University Medical Center, Rostock, Germany
  • Peter Fuller
    Department of Endocrinology, Monash Health, Clayton, Australia
  • Jun Yang
    Department of Endocrinology, Monash Health, Clayton, Australia
  • Nicholas Yong Nian Chee
    Department of Endocrinology, Monash Health, Clayton, Australia
  • Steven B Magill
    Medical College of Wisconsin, Endocrinology Center, North Hills Health Center, Menomonee Falls, Wisconsin
  • Zulfiya Shafigullina
    Department of Endocrinology, North-Western State Medical University named after I.I. Mechnikov, St. Petersburg, Russia
  • Marcus Quinkler
    Endocrinology in Charlottenburg, Berlin, Germany
  • Anna Oliveras
    Nephrology Department, Hospital del Mar Universitat Autònoma de Barcelona, Barcelona, Spain
  • Chin-Chen Chang
    Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
  • Vin Cent Wu
    Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
  • Zusana Somloova
    3rd Department of Medicine, Charles University Prague, General Hospital, Prague, Czech Republic
  • Giuseppe Maiolino
    Department of Medicine-DIMED, University Hospital, Padova, Italy
  • Giulio Barbiero
    Institute of Radiology, University of Padova, Padova, Italy
  • Michele Battistel
    Institute of Radiology, University of Padova, Padova, Italy
  • Livia Lenzini
    Department of Medicine-DIMED, University Hospital, Padova, Italy
  • Emilio Quaia
    Institute of Radiology, University of Padova, Padova, Italy
  • Achille Cesare Pessina
    Department of Medicine-DIMED, University Hospital, Padova, Italy
  • Gian Paolo Rossi
    Department of Medicine-DIMED, University Hospital, Padova, Italy
  • Institut National de la Santé et de la Recherche Médicale (INSERM)
  • HULOT, Jean-Sébastien

Description

<jats:title>Abstract</jats:title> <jats:sec> <jats:title>Context</jats:title> <jats:p>Adrenal venous sampling (AVS) is the key test for subtyping primary aldosteronism (PA), but its interpretation varies widely across referral centers and this can adversely affect the management of PA patients.</jats:p> </jats:sec> <jats:sec> <jats:title>Objectives</jats:title> <jats:p>To investigate in a real-life study the rate of bilateral success and identification of unilateral aldosteronism and their impact on blood pressure outcomes in PA subtyped by AVS.</jats:p> </jats:sec> <jats:sec> <jats:title>Design and settings</jats:title> <jats:p>In a retrospective analysis of the largest international registry of individual AVS data (AVIS-2 study), we investigated how different cut-off values of the selectivity index (SI) and lateralization index (LI) affected rate of bilateral success, identification of unilateral aldosteronism, and blood pressure outcomes.</jats:p> </jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>AVIS-2 recruited 1625 individual AVS studies performed between 2000 and 2015 in 19 tertiary referral centers. Under unstimulated conditions, the rate of biochemically confirmed bilateral AVS success progressively decreased with increasing SI cut-offs; furthermore, with currently used LI cut-offs, the rate of identified unilateral PA leading to adrenalectomy was as low as &lt;25%. A within-patient pairwise comparison of 402 AVS performed both under unstimulated and cosyntropin-stimulated conditions showed that cosyntropin increased the confirmed rate of bilateral selectivity for SI cut-offs ≥ 2.0, but reduced lateralization rates (P &lt; 0.001). Post-adrenalectomy outcomes were not improved by use of cosyntropin or more restrictive diagnostic criteria.</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusion</jats:title> <jats:p>Commonly used SI and LI cut-offs are associated with disappointingly low rates of biochemically defined AVS success and identified unilateral PA. Evidence-based protocols entailing less restrictive interpretative cut-offs might optimize the clinical use of this costly and invasive test. (J Clin Endocrinol Metab XX: 0-0, 2020)</jats:p> </jats:sec>

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