scholarly journals Aldosterone Suppression on Contralateral Adrenal During Adrenal Vein Sampling Does Not Predict Blood Pressure Response After Adrenalectomy

2014 ◽  
Vol 99 (11) ◽  
pp. 4158-4166 ◽  
Author(s):  
Silvia Monticone ◽  
Fumitoshi Satoh ◽  
Andrea Viola ◽  
Evelyn Fischer ◽  
Oliver Vonend ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Blood Pressure Response ◽  
Blood Pressure Reduction ◽  
Great Majority ◽  
Adrenal Vein ◽  
Curative Surgery ◽  
Adrenal Vein Sampling ◽  
Unilateral Adrenalectomy ◽  
Contralateral Suppression ◽  
Bilateral Adrenal Hyperplasia

Context: Adrenal vein sampling (AVS) is the only reliable means to distinguish between aldosterone-producing adenoma and bilateral adrenal hyperplasia, the two most common subtypes of primary aldosteronism (PA). AVS protocols are not standardized and vary widely between centers. Objective: The objective of the study was to retrospectively investigate whether the presence of contralateral adrenal (CL) suppression of aldosterone secretion was associated with improved postoperative outcomes in patients who underwent unilateral adrenalectomy for PA. Setting: The study was carried out in eight different referral centers in Italy, Germany, and Japan. Patients: From 585 consecutive AVS in patients with confirmed PA, 234 procedures met the inclusion criteria and were used for the subsequent analyses. Results: Overall, 82% of patients displayed contralateral suppression. This percentage was significantly higher in ACTH stimulated compared with basal procedures (90% vs 77%). The CL ratio was inversely correlated with the aldosterone level at diagnosis and, among AVS parameters, with the lateralization index (P = .02 and P = .01, respectively). The absence of contralateral suppression was not associated with a lower rate of response to adrenalectomy in terms of both clinical and biochemical parameters, and patients with CL suppression underwent a significantly larger reduction in the aldosterone levels after adrenalectomy. Conclusions: For patients with lateralizing indices of greater than 4 (which comprised the great majority of subjects in this study), CL suppression should not be required to refer patients to adrenalectomy because it is not associated with a larger blood pressure reduction after surgery and might exclude patients from curative surgery.

scholarly journals Lack of influence of somatic mutations on steroid gradients during adrenal vein sampling in aldosterone-producing adenoma patients

2013 ◽  
Vol 169 (5) ◽  
pp. 657-663 ◽  
Author(s):  
Andrea Oßwald ◽  
Evelyn Fischer ◽  
Christoph Degenhart ◽  
Marcus Quinkler ◽  
Martin Bidlingmaier ◽  
...  
Keyword(s):  
Contralateral Side ◽  
Adrenal Vein ◽  
Genetic Modifiers ◽  
Adrenal Vein Sampling ◽  
Unilateral Adrenalectomy ◽  
Mutation Status ◽  
Mutation Carriers ◽  
Contralateral Suppression ◽  
Aldosterone Producing Adenoma ◽  
Index Ratio

ObjectiveAdrenal vein sampling (AVS) is a technically demanding procedure required for the identification of suitable candidates for unilateral adrenalectomy in primary aldosteronism. Recently, somaticKCNJ5K+-channel mutations in aldosterone-producing adenoma (APA) patients have been shown to influence steroid gradients during AVS. These and other recently identified genetic modifiers (ATP1A1andATP2B3) might affect the final diagnosis and treatment of the affected patients.DesignFifty-nine patients with APAs who had undergone successful AVS (adrenal vein cortisol:peripheral cortisol ratio ≥2) and had undergone a mutation analysis of their tumor tissue were studied. The mutation status of the APAs was as follows: 19KCNJ5mutations, eight ATPase mutations (fiveATP1A1and threeATP2B3), and 32 patients with none of these mutations.MethodsThe lateralization index (ratio of aldosterone:cortisol on the side of the adenoma to aldosterone to cortisol on the contralateral side) and the contralateral suppression index (ratio of aldosterone:cortisol on the contralateral side to aldosterone to cortisol in the periphery) were calculated for theKCNJ5-mutated, ATPase-mutated, and theKCNJ5/ATPase mutation-negative APA patients.ResultsThe lateralization indices of the ATPase mutation carriers had a median of 19.9 compared with a median of 16.0 in theKCNJ5mutation carriers and that of 20.5 in theKCNJ5/ATPase mutation-negative patients. The contralateral suppression indices of the ATPase-mutated patients had a median of 0.1 compared with a median of 0.4 in theKCNJ5mutation carriers and that of 0.2 in theKCNJ5/ATPase mutation-negative patients. The differences between the genetic groups were not statistically significant.ConclusionsWe did not find evidence for a clinically important impact of mutation status on steroid gradients during AVS.

Abstract 161: African Ancestry and Blood Pressure Response Among African Americans in the Systolic Blood Pressure Reduction Intervention Trial

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Shreya Rao ◽  
Matthew W Segar ◽  
Kershaw Patel ◽  
Ambarish Pandey
Keyword(s):  
Blood Pressure ◽  
Kidney Function ◽  
Blood Pressure Response ◽  
African Ancestry ◽  
Blood Pressure Reduction ◽  
Response To Therapy ◽  
Mixed Effect ◽  
Cox Models ◽  
Treatment Interaction ◽  
Over Time

Introduction: African ancestry (AA) is associated with higher BP prevalence, however the association of AA with response to intensive BP therapy, kidney function changes, and CV outcomes has not previously been explored. Methods: The study included participants from the SPRINT trial with available AA proportion. AA proportion was estimated using 106 biallelic genotype markers. Participants were stratified into tertiles from lowest (T1) to highest (T3) AA percentage. Time-dependent changes in SBP and eGFR were assessed by linear mixed-effect modeling after adjustment for potential confounders. Multivariable Cox models were constructed to evaluate the association of AA with risk of composite CV events (non-fatal MI, CV death, and HF event). Results: Among 2479 participants (median AA 78% [IQR: 73-87%], age 62 y, 46% female), baseline BP was similar across tertiles. At baseline, the prevalence of average Framingham CV risk (T1 vs. T2 vs. T3: mean 18.2% vs. 17.3% vs. 16.7%, p=0.01) and eGFR decreased (78 vs. 77 vs. 74, p=0.003) across increasing tertiles of AA. In contrast, the burden of DM (1.4% vs. 1.2% vs. 2.7%, p=0.05) and LV hypertrophy by EKG increased across increasing AA tertiles (11.1% vs. 12.0% vs. 15.7%, p=0.02). On follow up, the decline in BP over time was consistent across AA tertiles (mean reduction in SBP: 10 vs. 7 vs. 11 mm Hg, p=0.19) with no treatment interaction by genetic ancestry (p-int=0.60, Fig. A ). However, there was a greater decline in kidney function over time from T3 vs. T1 (mean eGFR decline = 3.8, 3.3, and 5.0 in T1-3) ( Fig. B ). The risk of adverse CV event was not different across AA tertiles [adjusted HR (95% CI): T3 vs. T1 = 0.93 (0.61-1.44); T2 vs T1 = 0.69 (0.42-1.11)]. Conclusions: Genetic AA was not significantly associated with baseline BP level or response to therapy in the SPRINT trial. Higher genetic African ancestry was associated with favorable CV risk profiles with no difference in adverse CV event risk, but greater decline in renal function over time.

ADRENAL VEIN SAMPLING WITHOUT DISCONTINUATION OF MINERALOCORTICOID RECEPTOR ANTAGONIST THERAPY

2020 ◽  
Vol 26 (9) ◽  
pp. 953-959
Author(s):  
Malini Ganesh ◽  
Shabirhusain S. Abadin ◽  
Leon Fogelfeld
Keyword(s):  
Plasma Renin Activity ◽  
Mineralocorticoid Receptor ◽  
Plasma Renin ◽  
Plasma Aldosterone ◽  
Adrenal Vein ◽  
Adrenal Vein Sampling ◽  
Mineralocorticoid Receptor Antagonist ◽  
Plasma Aldosterone Concentration ◽  
Contralateral Suppression ◽  
Lateralization Index

Objective: Guidelines recommend withdrawing mineralocorticoid-receptor antagonists (MRAs) for 4 weeks prior to adrenal vein sampling (AVS), but this is not always feasible because of hypertension and hypokalemia. This retrospective study of primary aldosteronism (PA) patients who underwent AVS between 2008 and 2018 assessed the effect of continuing MRA on the AVS procedure. Methods: Clinical data including antihypertensive regimen defined by the World Health Organization Daily Defined Dose (DDD) system were collected for 19 patients with adequate cannulation and lateralization during AVS. Results were compared between 5 patients who continued and 14 patients who discontinued MRA therapy (MRA and non-MRA groups). Results: At diagnosis, plasma renin activity, plasma aldosterone concentration (PAC), potassium (K) doses, and DDD were not significantly different between groups. Aldosterone-renin ratio was significantly higher in the MRA group (median, 375.0; interquartile range [IQR], 224.8 to 544.3 vs. 148.7, 118.4 to 192.1; P = .034). No difference was found in lateralization index (median 48.3; IQR, 23.6 to 52.1 vs. 8.7; 4.9 to 20.2; P = .10). Contralateral suppression, defined as aldosterone-cortisol ratio of unaffected adrenal to periphery, trended lower in the MRA group (median, 0.17; IQR, 0.03 to 0.39 vs. 0.51; 0.27 to 1.1; P = .056). All five MRA patients underwent successful adrenalectomy with at least 50% reduction in DDD and PAC and normal K postoperatively. One MRA patient did not lateralize, which was confirmed on repeat AVS, after MRA withdrawal. Conclusion: Continuation of MRA may not interfere with AVS lateralization or affect contralateral adrenal suppression. Continuation of MRA in preparation for AVS may be considered, especially in patients with severe PA, to avoid uncontrolled hypertension and severe hypokalemia. Abbreviations: ACTH = adrenocorticotropic hormone; APA = aldosterone-producing adenoma; ARR = aldosterone-renin ratio; AV = adrenal vein; AVS = adrenal vein sampling; CS = contralateral suppression; DDD = daily defined dose; IQR = interquartile range; K = potassium; LI = lateralization index; MRA = mineralocorticoid receptor antagonist; PA = primary aldosteronism; PAC = plasma aldosterone concentration; PRA = plasma renin activity

scholarly journals KCNJ5 Somatic Mutation Is a Predictor of Hypertension Remission After Adrenalectomy for Unilateral Primary Aldosteronism

2019 ◽  
Vol 104 (10) ◽  
pp. 4695-4702 ◽  
Author(s):  
Leticia A P Vilela ◽  
Marcela Rassi-Cruz ◽  
Augusto G Guimaraes ◽  
Caio C S Moises ◽  
Thais C Freitas ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Somatic Mutation ◽  
Primary Aldosteronism ◽  
Antihypertensive Drugs ◽  
Independent Predictor ◽  
Blood Pressure Response ◽  
Antihypertensive Medications ◽  
Unilateral Adrenalectomy ◽  
Molecular Features ◽  
Endocrine Hypertension

AbstractContextPrimary aldosteronism (PA) is the most common cause of endocrine hypertension (HT). HT remission (defined as blood pressure <140/90 mm Hg without antihypertensive drugs) has been reported in approximately 50% of patients with unilateral PA after adrenalectomy. HT duration and severity are predictors of blood pressure response, but the prognostic role of somatic KCNJ5 mutations is unclear.ObjectiveTo determine clinical and molecular features associated with HT remission after adrenalectomy in patients with unilateral PA.MethodsWe retrospectively evaluated 100 patients with PA (60 women; median age at diagnosis 48 years with a median follow-up of 26 months). Anatomopathological analysis revealed 90 aldosterone-producing adenomas, 1 carcinoma, and 9 unilateral adrenal hyperplasias. All patients had biochemical cure after unilateral adrenalectomy. KCNJ5 gene was sequenced in 76 cases.ResultsKCNJ5 mutations were identified in 33 of 76 (43.4%) tumors: p.Gly151Arg (n = 17), p.Leu168Arg (n = 15), and p.Glu145Gln (n = 1). HT remission was reported in 37 of 100 (37%) patients. Among patients with HT remission, 73% were women (P = 0.04), 48.6% used more than three antihypertensive medications (P = 0.0001), and 64.9% had HT duration <10 years (P = 0.0015) compared with those without HT remission. Somatic KCNJ5 mutations were associated with female sex (P = 0.004), larger nodules (P = 0.001), and HT remission (P = 0.0001). In multivariate analysis, only a somatic KCNJ5 mutation was an independent predictor of HT remission after adrenalectomy (P = 0.004).ConclusionThe presence of a KCNJ5 somatic mutation is an independent predictor of HT remission after unilateral adrenalectomy in patients with unilateral PA.

scholarly journals Basal and Activated Calcium Sensitization Mediated by RhoA/Rho Kinase Pathway in Rats with Genetic and Salt Hypertension

2017 ◽  
Vol 2017 ◽  
pp. 1-13 ◽  
Author(s):  
Michal Behuliak ◽  
Michal Bencze ◽  
Ivana Vaněčková ◽  
Jaroslav Kuneš ◽  
Josef Zicha
Keyword(s):  
Blood Pressure ◽  
Kinase Inhibitor ◽  
Blood Pressure Response ◽  
Blood Pressure Reduction ◽  
Rho Kinase ◽  
Experimental Hypertension ◽  
Acute Administration ◽  
Calcium Sensitization ◽  
Rho Kinase Inhibitor ◽  
Kinase Pathway

Calcium sensitization mediated by RhoA/Rho kinase pathway can be evaluated either in the absence (basal calcium sensitization) or in the presence of endogenous vasoconstrictor systems (activated calcium sensitization). Our aim was to compare basal and activated calcium sensitization in three forms of experimental hypertension with increased sympathetic tone and enhanced calcium entry—spontaneously hypertensive rats (SHR), heterozygous Ren-2 transgenic rats (TGR), and salt hypertensive Dahl rats. Activated calcium sensitization was determined as blood pressure reduction induced by acute administration of Rho kinase inhibitor fasudil in conscious rats with intact sympathetic nervous system (SNS) and renin-angiotensin system (RAS). Basal calcium sensitization was studied as fasudil-dependent difference in blood pressure response to calcium channel opener BAY K8644 in rats subjected to RAS and SNS blockade. Calcium sensitization was also estimated from reduced development of isolated artery contraction by Rho kinase inhibitor Y-27632. Activated calcium sensitization was enhanced in all three hypertensive models (due to the hyperactivity of vasoconstrictor systems). In contrast, basal calcium sensitization was reduced in SHR and TGR relative to their controls, whereas it was augmented in salt-sensitive Dahl rats relative to their salt-resistant controls. Similar differences in calcium sensitization were seen in femoral arteries of SHR and Dahl rats.

scholarly journals Basal and Post-ACTH Aldosterone and Its Ratios Are Useful During Adrenal Vein Sampling in Primary Aldosteronism

2016 ◽  
Vol 101 (4) ◽  
pp. 1826-1835 ◽  
Author(s):  
Nada El Ghorayeb ◽  
Tânia L. Mazzuco ◽  
Isabelle Bourdeau ◽  
Jean-Philippe Mailhot ◽  
Ping Shi Zhu ◽  
...  
Keyword(s):  
Primary Aldosteronism ◽  
Outcome Data ◽  
Adrenal Vein ◽  
Selectivity Ratio ◽  
Peripheral Vein ◽  
Adrenal Vein Sampling ◽  
Contralateral Suppression ◽  
Before And After ◽  
Cortisol Ratio ◽  
Rate Of Response

Abstract Context: Adrenal vein sampling (AVS) is required to identify a lateralized or bilateral aldosterone source in primary aldosteronism. Objectives: Our objectives were to compare basal and post-ACTH selectivity ratio (SR) and lateralization ratio (LR) and to determine the prevalence of basal contralateral suppression and its effect on surgical outcome. Patients and Intervention: Bilateral simultaneous adrenal vein samples were obtained before and after a 250-μg bolus of ACTH. Analyses were conducted on 171 technically successful AVS and on the subgroup of 66 operated patients with evaluable outcome data. Results: ACTH increased selectivity on both sides from 66.7% in basal samples (SR ≥ 2) to 91.8% poststimulation (SR ≥ 5). A discordance of lateralization between basal (LR ≥ 2) and post-ACTH (LR ≥ 4) values was observed in 28% of cases, which were mostly lateralized cases basally that became bilateral post-ACTH. Basal CL suppression is present in only 30% using absolute ratio of aldosterone between the opposite (nondominant) adrenal vein and the peripheral vein AOPP/AP below 1.5 vs in 77% using aldosterone/cortisol ratio (A/C)OPP/(A/C)P below 1.5. The absence of CL suppression was associated with a lower rate of response to adrenalectomy in terms of clinical and biochemical parameters with difference in clinical cure (55% vs 13% P = .0003) and overall cure (35% vs 9%, P = .0084) using AOPP/AP, but not when using (A/C)OPP/(A/C)P. Conclusions: Stimulation with ACTH is useful to improve selectivity of AVS but can frequently modify interpretation of lateralization. Basal ratios are as important as post-ACTH ratios to set an indication of adrenalectomy. AOPP/AP is superior to (A/C)OPP/(A/C)P to assess contralateral suppression. Infrequent CL suppression reveals frequent occurrence of contralateral hyperplasia in lateralized cases and helps predict postoperative outcomes.

scholarly journals Combined Efficacy of Adrenal Vein Sampling and Imaging Findings in Predicting Clinical Outcomes Following Unilateral Adrenalectomy for Primary Aldosteronism

2017 ◽  
Vol 01 (02) ◽  
pp. 071-076
Author(s):  
Rajiv Srinivasa ◽  
Matthew Anderson ◽  
Alan Dackiw ◽  
Anil Pillai ◽  
Clayton Trimmer ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Renal Function ◽  
Clinical Outcomes ◽  
Blood Pressure Control ◽  
Pressure Control ◽  
Preoperative Imaging ◽  
Imaging Findings ◽  
Adrenal Vein Sampling ◽  
Unilateral Adrenalectomy ◽  
Adrenal Nodule

AbstractThe objective of this study was to investigate the combined efficacy of adrenal vein sampling (AVS) and imaging findings in predicting successful clinical outcomes following unilateral adrenalectomy for primary aldosteronism (PA). A retrospective chart review of 137 patients who underwent AVS between 2009 and 2014 at two hospitals in a single academic institution was performed. Preprocedure demographic, imaging, medication, and laboratory values were reviewed. In general, patients were considered for adrenalectomy when lateralization was suggested on AVS. Clinical outcomes such as improved blood pressure control and preserved renal function after adrenalectomy were correlated with preprocedure variables. AVS was technically successful in 120 out of 137 patients. Lateralization was seen in 64 patients and 48 out of 64 patients underwent adrenalectomy. Out of 48, 43 patients had an adrenal nodule on preoperative imaging, while 5 did not. 28 patients showed improvement in blood pressure after adrenalectomy, all of which had a nodule on imaging. Of the 28 patients, 22 also showed preservation of renal function. None of the remaining 5 (out of 48) patients who demonstrated lateralization on AVS and had no nodule on imaging showed clinical improvement following adrenalectomy. The presence of an adrenal nodule on preoperative imaging was also associated with improved blood pressure control (p = 0.022) and preserved renal function (p = 0.048) following adrenalectomy. Improved blood pressure control and preserved renal function in patients with PA who underwent adrenalectomy following lateralization on AVS are associated with the identification of an adrenal nodule on preoperative imaging.

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