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Adrenal Vein Sampling Results and Surgical Outcomes in Patients with a Normal Plasma Aldosterone Concentration. | LitMetric

AI Article Synopsis

  • The study aimed to evaluate the effectiveness of adrenal vein sampling (AVS) and the outcomes of adrenalectomy in patients with normal plasma aldosterone concentration (PAC) but elevated aldosterone-to-renin ratio (ARR).
  • It included 106 patients with normal PAC (5-15 ng/dL) and 106 patients with high PAC (>15 ng/dL) who underwent AVS, revealing that fewer in the normal PAC group had a significant lateralization index compared to those with high PAC.
  • Despite the differences in lateralization, both groups showed similar improvements in hypertension and hypokalemia after adrenalectomy, suggesting that patients with normal PAC may still benefit from AVS if they have elevated ARR.

Article Abstract

Purpose: To determine the utility of adrenal vein sampling (AVS) and outcomes after adrenalectomy in patients with normal plasma aldosterone concentration (PAC) and elevated aldosterone-to-renin ratio (ARR).

Materials And Methods: The study sample included 106 patients with ARR greater than 20 and PAC between 5 and 15 ng/dL (normal PAC group) who underwent AVS from 2005 to 2021. These patients were compared with a cohort of 106 patients with ARR >20 and PAC >15 ng/dL (high PAC group) who underwent AVS during the same period. Data regarding baseline clinical characteristics, lateralization indices from AVS, and outcomes after adrenalectomy were analyzed.

Results: AVS was technically successful in 210 patients (210/212, 99%). A smaller proportion of patients in the normal PAC group showed a lateralization index of >4 compared with those in the high PAC group (44% vs 64%, P <.01). A similar proportion of patients in the normal PAC group experienced improved or cured hypertension after adrenalectomy compared with that in the high PAC group (94% vs 88%, P =.31). Hypokalemia was cured in all patients in the normal PAC group after adrenalectomy compared with 98% of patients in the high PAC group (100% vs 98%, P = 1).

Conclusions: Although lateralization is less frequent for patients with normal PAC, patients who do lateralize show similar blood pressure response and correction of hypokalemia after adrenalectomy, regardless of initial plasma aldosterone levels. Therefore, patients with PAC <15 ng/dL should still be considered for AVS provided the ARR is elevated.

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Source
http://dx.doi.org/10.1016/j.jvir.2022.12.003DOI Listing

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