Contralateral suppression in adrenal venous sampling predicts clinical and biochemical outcome in primary aldosteronism

Jessica Okubo; Paula Frudit; Aline Cavalcante; Ana Alice Maciel; Thais Castanheira; Bruna Pilan; Gustavo Fagundes; Nara Queiroz; Matheo Stumpf; Victor Souza; Eduardo Kawahara; Tatiana Goldbaum; Maria Adelaide Pereira; Vinicius Calsavara; Luciano Drager; Maria Candida Fragoso; Ana Claudia Latronico; Berenice Mendonca; Francisco Carnevale; Madson Almeida

doi:10.1530/endoabs.99.RC11.2

RC11.2

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Endocrine Abstracts (2024) 99 RC11.2 | DOI: 10.1530/endoabs.99.RC11.2

ECE2024 Rapid Communications Rapid Communications 11: Adrenal and Cardiovascular Endocrinology | Part II (7 abstracts)

Contralateral suppression in adrenal venous sampling predicts clinical and biochemical outcome in primary aldosteronism

Jessica Okubo ¹ , Paula Frudit ¹ , Aline Cavalcante ² , Ana Alice Maciel ¹ , Thais Castanheira ¹ , Bruna Pilan ² , Gustavo Fagundes ¹ , Nara Queiroz ¹ , Matheo Stumpf ¹ , Victor Souza ¹ , Eduardo Kawahara ¹ , Tatiana Goldbaum ¹ , Maria Adelaide Pereira ¹ , Vinicius Calsavara ³ , Luciano Drager ⁴ , Maria Candida Fragoso ⁵ , Ana Claudia Latronico ⁵ , Berenice Mendonca ⁵ , Francisco Carnevale ² & Madson Almeida ¹

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¹Unidade de Adrenal, Laboratório de Endocrinologia Molecular e Celular LIM25, Divisão de Endocrinologia e Metabologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil; ²Divisão de Radiologia Intervencionista, Instituto de Radiologia InRAD, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil; ³Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, United States; ⁴Unidade de Hipertensão, Divisião de Nefrologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil; ⁵Unidade de Adrenal, Laboratório de Hormônios e Genética Molecular LIM42, Divisão de Endocrinologia e Metabologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil

Context: The role for hormone parameters at adrenal venous sampling (AVS) in predicting clinical and biochemical outcome remains controversial.

Objective: To investigate the impact of hormone parameters at AVS under cosyntropin stimulation on lateralization and on complete biochemical and clinical outcome.

Methods: We retrospectively evaluated 168 sequential AVS under cosyntropin infusion. Bilateral successful cannulation rate was 83.3% (n= 140), 47.9% bilateral and 52.1% unilateral. The lateralization index (LI), aldosterone/cortisol ratio (A/C) in the dominant adrenal vein (AV), relative aldosterone secretion index (RASI= A/C in AV divided by A/C in inferior vena cava) were assessed. The contralateral suppression (CS) percentage was defined by (1 – nondominant RASI) ×100.

Results: A nondominant RASI <0.5 (CS >50%) had 86.84% sensitivity and 92.96% specificity to predict contralateral lateralization. An A/C ratio in dominant AV >5.9 (74.67% sensitivity and 80% specificity) and dominant RASI >4.7 (35.21% sensitivity and 88.06% specificity) had a worst performance to predict ipsilateral lateralization. Complete biochemical and clinical cure were significantly more frequent in the patients with CS >50% [98.41% vs 42.86% (p <0.001) and 41.94% vs 0% (P<0.001)]. CS correlated with high aldosterone at diagnosis (p <0.001) and low postoperative aldosterone levels at 1 month (P=0.019). Postoperative biochemical hypoaldosteronism was more frequent in patients with CS >50% (70% vs 16.67%, P=0.014). In multivariable analysis, a CS >50% was associated with complete biochemical cure (OR 125, 95%CI 11.904–5,000; P=0.001) and hypertension remission (OR 12.19, 95%CI 2.074–250; P=0.023).

Conclusion: A CS >50% was an independent predictor of complete clinical and biochemical cure. Moreover, it can predict unilateral PA and postoperative biochemical hypoaldosteronism. Our findings underscore the usefulness of CS for clinical decision-making.