Introduction: Primary aldosteronism (PA) causes 15–25% of cases of drug-resistant hypertension (RBP). Adrenal vein sampling (AVS) is considered the gold standard for diagnosis of aldosterone aberrant secretion origin. The distinction between unilateral and bilateral disease dictates the targeted therapeutic approach, with surgery for aldosterone producing adenomas and medical therapy for patients with bilateral hyperplasia. As AVS is an invasive, not well standardized procedure and it is restricted to few specialized centers, several attempts have been made to simplify diagnostic algorithms by using abdominal imaging only. We aimed to compare how AVS changed the approach firstly chosen by CT-scan at our hospital.
Methods: A retrospective study in a single referral center was performed. All cases diagnosed with PA and in which CT scan and AVS were carried out, between 2006 and 2019, were included. We compare the CT scan-AVS concordance and we analyze the clinical decision that was taken and its result in terms of blood pressure control. For asses sampling quality we used an index cutoff of 1.1.
Results: We included 36 patients. 21 men/15 women. Mean age 60.8 y.o.. Diagnosis of PA was made due to suspicion of secondary RBP in 34 patients and due to an adrenal incidentaloma in 2 patients. CT-scan showed unilateral adenoma in 28 patients and hyperplasia or bilateral adenomas in 8 patients. In AVS, left AV was adequately sampled in 97% and right AV in 78%. In 20 patients (55,5%) AVS and CT-scan agreed, thus, initial therapeutic achievement did not change. In 12 patients, CT-Scan showed unilateral adenoma but AVS displayed no lateralization. All these patients were treated successfully with medical therapy except 2 patients who underwent surgery. One was cured but in other HBP persisted. In 3 patients, CT-scan showed bilateral disease but AVS displayed lateralization. One was treated with surgery and was cured. Other was treated successfully with drugs and other is waiting for surgery. Finally, one patient presented with a right adenoma and AVS displayed left lateralization. She was treated medically. Overall, 18 (50%) patients have been operated, and RBP has been cured in 8 and the rest has significantly reduced the number of antihypertensive drugs.
Conclusion: In 55% of patients, AVS confirms the abdominal imaging and the initial approach would not change. However, in 43% of patients AVS and CT-scan did not correlate. Thus, AVS can significantly improve the choice of treatment modality.
05 - 09 Sep 2020
European Society of Endocrinology