Introduction: In a prospective within-patient study (MATCH) 11C-metomidate PET-CT (MTO) was an accurate non-invasive alternative to adrenal vein sampling in the detection of unilateral PA1. Post-adrenalectomy (ADX), 24/78 (30%) patients achieved complete clinical success (PASO consensus) at 6 months, but 75% achieved reduction in B-type natriuretic peptide (BNP).
Aim: To determine: 1. the number of patients who sustain complete clinical success, and reduction in BNP, at 2 years, 2. whether tumour genotype associates with likelihood of sustained cure, and can be predicted from the baseline urinary 18-OH cortisol/cortisol (hybrid steroid) ratio.
Results: 63/78 ADX patients have completed 2-year follow-up. 20 of the 24 patients (83%) with complete clinical success at 6 months continue to have an average home BP <135/85mmHg, off treatment, at 2 years. In 18/78 patients, the aldosterone-producing-adenoma had a KCNJ5 (K+-channel) mutation; 14 achieved complete clinical success at both 6 and 24 months. Two patients with a double-mutation of CTNNB1/GNAQ also showed complete clinical success at 6 and 24 months. By contrast, 20/78 ADX patients had a CACNA1D (Ca++-channel) mutation, of whom 3 and 1 patients, respectively, were clinically cured at 6 and 24 months. The hybrid steroid ratio at baseline, measured in 66/78 patients, separated patients with KCNJ5 mutations (6.4(
Conclusion: Complete cure of hypertension, achieved in a minority of ADX patients, is likely to be sustained for at least 2 years. Most complete cures are of patients with a KCNJ5 mutation, who are potentially predicted by their urine hybrid-steroid ratio. The majority of ADX patients have a substantial reduction in BNP, indicating the benefits, beyond cure of hypertension, of suppressing autonomous aldosterone production.
Reference 1. Wu et al. DOI:10.21203/rs.3.rs-1179128/v1.2021.
14 Nov 2022 - 16 Nov 2022