Publication: Adrenal Vein Sampling Lateralization Despite Mineralocorticoid Receptor Antagonists Exposure in Primary Aldosteronism
Issued Date
2018-11-09
Resource Type
ISSN
19457197
0021972X
0021972X
Other identifier(s)
2-s2.0-85059496380
Rights
Mahidol University
Rights Holder(s)
SCOPUS
Bibliographic Citation
Journal of Clinical Endocrinology and Metabolism. Vol.104, No.2 (2018), 487-492
Suggested Citation
Aya T. Nanba, Taweesak Wannachalee, James J. Shields, James B. Byrd, William E. Rainey, Richard J. Auchus, Adina F. Turcu Adrenal Vein Sampling Lateralization Despite Mineralocorticoid Receptor Antagonists Exposure in Primary Aldosteronism. Journal of Clinical Endocrinology and Metabolism. Vol.104, No.2 (2018), 487-492. doi:10.1210/jc.2018-01299 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/44999
Research Projects
Organizational Units
Authors
Journal Issue
Thesis
Title
Adrenal Vein Sampling Lateralization Despite Mineralocorticoid Receptor Antagonists Exposure in Primary Aldosteronism
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.