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Please use this identifier to cite or link to this item: http://repository.li.mahidol.ac.th/dspace/handle/123456789/44999
Title: Adrenal Vein Sampling Lateralization Despite Mineralocorticoid Receptor Antagonists Exposure in Primary Aldosteronism
Authors: Aya T. Nanba
Taweesak Wannachalee
James J. Shields
James B. Byrd
William E. Rainey
Richard J. Auchus
Adina F. Turcu
University of Michigan Medical School
University of Michigan, Ann Arbor
Faculty of Medicine, Siriraj Hospital, Mahidol University
Keywords: Biochemistry, Genetics and Molecular Biology;Medicine
Issue Date: 9-Nov-2018
Citation: Journal of Clinical Endocrinology and Metabolism. Vol.104, No.2 (2018), 487-492
Abstract: © Copyright 2019 Endocrine Society. Context Many antihypertensive medications modulate the renin-angiotensin-aldosterone system, possibly skewing the diagnosis and subtyping of primary aldosteronism (PA). Particularly, mineralocorticoid receptor antagonists (MRA) might raise renin and stimulate aldosterone synthesis from nonautonomous areas, potentially obscuring lateralization on adrenal vein sampling (AVS). Withdrawal of MRA in severe PA, however, can precipitate hypokalemia and/or hypertension and therefore is not always practical. Objective To assess the effects of MRA on the interpretation of AVS data. Design and Participants A cohort study of all PA patients who underwent AVS at University of Michigan between January 2009 and January 2018 was conducted. Demographics, diagnostic, AVS, surgical pathology, and follow-up data were collected retrospectively. Results Of 191 patients who underwent AVS, 51 (27%) were exposed to MRA at the time of the procedure. Plasma aldosterone concentration and the daily defined dose of antihypertensives were higher in patients taking vs those not taking MRA. Unilateral PA was more frequent in the MRA group, both precosyntropin and postcosyntropin (P < 0.05). The MRA group included two patients with unsuppressed renin, who demonstrated unequivocal AVS lateralization. To date, 86 patients underwent unilateral adrenalectomy, including 30 patients taking MRA during AVS. The proportion of clinical and biochemical success was not statistically different between patients exposed to and those not exposed to MRA during AVS (P = 0.17 and 0.65, respectively). Conclusion Our data suggest that conclusive AVS lateralization is often achieved in patients with severe PA despite MRA use.
URI: https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85059496380&origin=inward
http://repository.li.mahidol.ac.th/dspace/handle/123456789/44999
ISSN: 19457197
0021972X
Appears in Collections:Scopus 2018

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