ECE2022 Oral Communications Oral Communications 13: Adrenal and Cardiovascular Endocrinology 2 (6 abstracts)
Early post-operative ACTH-stimulated aldosterone predicts long-term biochemical outcome in primary aldosteronism
Denise Bruedgam 1 , Christian Adolf 1 , Holger Schneider 1 , Verena Wegmann 1 , Paul Schwarzlmueller 1 , Lisa Mueller 1 , Finn Holler 1 , Benjamin Lechner 1 , Laura Handgriff 1 , Roland Ladurner 2 , Sinan Deniz 3 , Tracy Ann Williams 1,4 , Felix Beuschlein 1,5 , Martin Reincke 1 & Daniel Heinrich 1
1LMU Klinikum Innenstadt, Medizinische Klinik und Poliklinik IV, München, Germany; 2LMU Klinikum Innenstadt, Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Campus Innenstadt, Klinikum der Universität München, München, Germany; 3LMU Klinikum Innenstadt, Klinik und Poliklinik für Radiologie, München, Germany; 4Division of Internal Medicine and Hypertension, Department of Medical Sciences, University of Turin, Turin, Italy; 5University Hospital of Zürich, Klinik für Endokrinologie, Diabetologie und Klinische Ernährung, Zürich, Switzerland
Introduction: Primary aldosteronism (PA) is the most common surgically curable cause for endocrine hypertension. Patients with unilateral aldosterone-producing adenoma undergo adrenalectomy (ADX). Clinical and biochemical outcome is assessed 6-12 months after ADX according to PASO consensus. To reduce unnecessary follow-up visits and change in medication for diagnostic purposes for potentially cured patients after ADX, a prediction tool is needed. Previous research had shown greater ACTH-responsiveness in unilateral disease. Thus, we analyzed if early post-operative ACTH-stimulated aldosterone can predict PASO outcomes.
Methods: We prospectively included 100 patients of the German Conn’s registry from 2015-2021, who underwent ADX and post-operative ACTH stimulation tests. 6-12 months after ADX we assessed blood pressure and biochemical remission according to PASO criteria. In addition, serum cortisol and plasma aldosterone concentrations (PAC) were measured before and 30 min after the application of 250 μg Synacthen® within the first week after ADX. We used ROC (receiver operating curve) analysis and paired baseline and stimulated PAC and serum cortisol to PASO outcomes.
Results: 81% of the patients had complete, 13% partial and 6% absent biochemical remission at 6-12 months after ADX. Complete clinical remission was observed in 28%. There was a significant correlation between biochemical outcome and ACTH-stimulated PAC values (P=0.01, r=0.53). Using 58.5 pg/ml as a cut-off, post-operative stimulated PAC had high sensitivity (95%) and reasonable specificity (74%) for predicting partial or absent biochemical remission at 6-12 months after ADX. Additionally, stimulated PAC AUC (area under the curve) values (0.89; CI 0.82-0.96) were significantly higher (P=0.03) than baseline PAC AUC (P=0.28). In contrast, baseline and stimulated serum cortisol levels were less useful (baseline cortisol AUC 0.60; CI 0.45-0.74), stimulated cortisol AUC 0.67; CI 0.54-0.80, (P=0.01; P=0.01). Blood pressure outcome AUC for baseline and stimulated serum cortisol and PAC ranged from 0.56-0.66, indicating a low predictive value.
Conclusions: In our series, low post-operative ACTH-stimulated PAC was predictive of biochemical remission after ADX. As post-operative ACTH stimulation tests are used to detect adrenal insufficiency, concurrent stimulated PAC measurements should be included in routine care. If confirmed, this approach could reduce follow-up visits to assess biochemical outcome.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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