Identification of Surgically Curable Primary Aldosteronism by Imaging in a Large, Multiethnic International Study

  • Gian Paolo Rossi
    University of Padova, Department of Medicine-DIMED, International PhD Program in Arterial Hypertension and Vascular Biology (ARHYVAB), University Hospital, Padova, Italy
  • Filippo Crimì
    University of Padova, Department of Medicine-DIMED, Institute of Radiology, University Hospital, Padova, Italy
  • Giacomo Rossitto
    University of Padova, Department of Medicine-DIMED, International PhD Program in Arterial Hypertension and Vascular Biology (ARHYVAB), University Hospital, Padova, Italy
  • Laurence Amar
    AP-HP, Hôpital Européen Georges-Pompidou, Hypertension Department and DMU CARTE, Paris, France
  • Michel Azizi
    AP-HP, Hôpital Européen Georges-Pompidou, Hypertension Department and DMU CARTE, Paris, France
  • Anna Riester
    Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, LMU München, Munich, Germany
  • Martin Reincke
    Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, LMU München, Munich, Germany
  • Christoph Degenhart
    Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, LMU München, Munich, Germany
  • Jiri Widimsky
    3rd Department of Medicine, Charles University, General Faculty 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
    Department of Internal Medicine, Radboud University Medical Center, HB Nijmegen, the Netherlands
  • Leo Schultze Kool
    Department of Radiology, Radboud University Medical Center, HB Nijmegen, the Netherlands
  • Tomaz Kocjan
    Department of Endocrinology, Diabetes and Metabolic Diseases, University Medical Center Ljubljana, Ljubljana, Slovenia
  • Aurelio Negro
    Department of Internal Medicine, Azienda Unità Sanitaria Locale, IRCCS Arcispedale S. Maria Nuova, Hypertension Unit, Reggio Emilia, Italy
  • Ermanno Rossi
    Department of Internal Medicine, Azienda Unità Sanitaria Locale, IRCCS Arcispedale S. Maria Nuova, Hypertension Unit, Reggio Emilia, Italy
  • Gregory Kline
    Foothills Medical Center, University of Calgary, Calgary, Alberta, Canada
  • Akiyo Tanabe
    Department of Diabetes, Endocrinology and Metabolism, National Center for Global Health and Medicine, Tokyo, Japan
  • Fumitoshi Satoh
    Division of Nephrology, Endocrinology, and Vascular Medicine, Tohoku University Hospital, Sendai, Japan
  • Lars Christian Rump
    Heinrich Heine University Düsseldorf, Nephrologie, 40225 Düsseldorf, Germany
  • Oliver Vonend
    Heinrich Heine University Düsseldorf, Nephrologie, 40225 Düsseldorf, Germany
  • Holger S Willenberg
    Division of Endocrinology and Metabolism, Rostock University Medical Center, Rostock, Germany
  • Peter J Fuller
    Endocrinology Unit, Monash Health, Clayton, Victoria, Australia
  • Jun Yang
    Endocrinology Unit, Monash Health, Clayton, Victoria, Australia
  • Nicholas Yong Nian Chee
    Endocrinology Unit, Monash Health, Clayton, Victoria, Australia
  • Steven B Magill
    Medical College of Wisconsin, Endocrinology Center, North Hills Health Center, Menomonee Falls, Wisconsin, USA
  • Zulfiya Shafigullina
    Department of Endocrinology, North-Western Medical University named after I. I. Mechnikov, Saint Petersburg, Russia
  • Marcus Quinkler
    Endocrinology in Charlottenburg, 10627 Berlin, Germany
  • Anna Oliveras
    Department of Nephrology, Hypertension Unit, Hospital del Mar; Universitat Pompeu Fabra; IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
  • Vin Cent Wu
    Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
  • Zuzana Kratka
    3rd Department of Medicine, Charles University, General Faculty Hospital, Prague, Czech Republic
  • Giulio Barbiero
    University of Padova, Department of Medicine-DIMED, Institute of Radiology, University Hospital, Padova, Italy
  • Teresa Maria Seccia
    University of Padova, Department of Medicine-DIMED, International PhD Program in Arterial Hypertension and Vascular Biology (ARHYVAB), University Hospital, Padova, Italy
  • Michele Battistel
    University of Padova, Department of Medicine-DIMED, Institute of Radiology, University Hospital, Padova, Italy

抄録

<jats:title>Abstract</jats:title> <jats:sec> <jats:title>Context</jats:title> <jats:p>Adrenal gland imaging is recommended by the current guidelines for the workup of primary aldosteronism (PA). However, its diagnostic performance has not been established in large, multiethnic cohorts of patients who undergo adrenal vein sampling (AVS) and adrenalectomy.</jats:p> </jats:sec> <jats:sec> <jats:title>Objective</jats:title> <jats:p>This work aims to assess the diagnostic accuracy of cross-sectional adrenal imaging.</jats:p> </jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>This international multicenter study took place in tertiary referral centers. A total of 1625 PA patients seeking surgical cure were enrolled in an international study involving 19 centers in North America, Europe, Asia, and Australia. Of these, 1311 (81%) had imaging data available and 369 (23%), who received a final diagnosis of surgically cured unilateral PA, were examined. Patients underwent AVS and imaging by computed tomography and/or magnetic resonance imaging. The accuracy of detection of unilateral PA at imaging was estimated by the area under the receiver operator characteristics curve using cure (biochemical and/or full clinical success) as the reference at follow-up after unilateral adrenalectomy.</jats:p> </jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>In the cohort of 1311 patients with imaging data available, 34% and 7% of cases showed no detectable or bilateral nodules, respectively. Imaging did not detect the culprit adrenal in 28% of the surgically cured unilateral PA patients. Moreover, the clinical outcome did not differ significantly between the imaging-positive and imaging-negative patients.</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusion</jats:title> <jats:p>Cross-sectional imaging did not identify a lateralized cause of disease in around 40% of PA patients and failed to identify the culprit adrenal in more than one-fourth of patients with unilateral PA.</jats:p> </jats:sec>

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