TY - JOUR
T1 - Node-by-node diagnosis for multiple ipsilateral nodules by segmental adrenal venous sampling in primary aldosteronism
AU - Tannai, Hiromitsu
AU - Makita, Kohzoh
AU - Koike, Yuya
AU - Kubo, Haremaru
AU - Nakai, Kazuki
AU - Yamazaki, Yuto
AU - Tsurutani, Yuya
AU - Saito, Jun
AU - Matsui, Seishi
AU - Kakuta, Yukio
AU - Sasano, Hironobu
AU - Nishikawa, Tetsuo
N1 - Funding Information:
We appreciate Dr Maki Nagata and Dr Atsushi Inoue (Department of Urology, Yokohama Rosai Hospital) for their excellent surgical skills in adrenalectomy and cooperative medical care for patients with primary aldosteronism (PA); Ms. Sachiko Suematsu (Endocrinology and Diabetes Center, Yokohama Rosai Hospital) for the gene mutational analysis; Mr. Fumihito Inoue and Ms. Ayako Iwasawa (Department of Radiology, Yokohama Rosai Hospital) for their assistance as radiologic technologists; and Editage ( www.editage.com ) for English language editing. This research was supported by AMED under Grant Number JP20hk0102060.
Funding Information:
We appreciate Dr Maki Nagata and Dr Atsushi Inoue (Department of Urology, Yokohama Rosai Hospital) for their excellent surgical skills in adrenalectomy and cooperative medical care for patients with primary aldosteronism (PA); Ms. Sachiko Suematsu (Endocrinology and Diabetes Center, Yokohama Rosai Hospital) for the gene mutational analysis; Mr. Fumihito Inoue and Ms. Ayako Iwasawa (Department of Radiology, Yokohama Rosai Hospital) for their assistance as radiologic technologists; and Editage (www.editage.com) for English language editing. This research was supported by AMED under Grant Number JP20hk0102060.
Publisher Copyright:
© 2022 The Authors. Clinical Endocrinology published by John Wiley & Sons Ltd.
PY - 2022
Y1 - 2022
N2 - Objectives: In patients with primary aldosteronism (PA), multiple adrenocortical nodules may be present on the surgical side. The aim of this study was to clarify the pathological diagnosis and the node-by-node diagnostic capability of segmental adrenal venous sampling (sAVS). Design: Retrospective study. Patients: A total of 162 patients who underwent adrenalectomy following sAVS were studied. Measurements: Multiple nodules on the surgical side were extracted while referring to contrast-enhanced computed tomography images. We also performed a detailed histopathological analysis of the resected specimens from patients undergoing sAVS, which included immunohistochemistry for CYP11B2. Results: In 11 (6.8%) patients, two to three nodules were detected on the surgical side. All patients were diagnosed by sAVS with at least one aldosterone-producing adenoma (APA) for localized aldosterone elevation in tributaries. Seven patients showed a lateralization index value of ≥4 after ACTH stimulation. Histopathologically and clinically, two patients had two or three CYP11B2-positive APAs, and the other nine patients both APAs and non-APAs. The positive predictive value of the most suspected APA, that is, the drainer that showed the highest aldosterone level by sAVS, was 11/11 (100%, 95% confidence interval [CI]: 71.5%–100%), while that for the second and third suspected APA was 3/7 (42.9%, 95% CI: 9.9%–81.6%), and they were significantly different (p =.01). Further, the positive predictive value of non-APA was 4/4 (100%, 95% CI: 39.8%–100%). Conclusions: The sAVS could correctly diagnose the aldosterone production in multiple ipsilateral adrenal nodules.
AB - Objectives: In patients with primary aldosteronism (PA), multiple adrenocortical nodules may be present on the surgical side. The aim of this study was to clarify the pathological diagnosis and the node-by-node diagnostic capability of segmental adrenal venous sampling (sAVS). Design: Retrospective study. Patients: A total of 162 patients who underwent adrenalectomy following sAVS were studied. Measurements: Multiple nodules on the surgical side were extracted while referring to contrast-enhanced computed tomography images. We also performed a detailed histopathological analysis of the resected specimens from patients undergoing sAVS, which included immunohistochemistry for CYP11B2. Results: In 11 (6.8%) patients, two to three nodules were detected on the surgical side. All patients were diagnosed by sAVS with at least one aldosterone-producing adenoma (APA) for localized aldosterone elevation in tributaries. Seven patients showed a lateralization index value of ≥4 after ACTH stimulation. Histopathologically and clinically, two patients had two or three CYP11B2-positive APAs, and the other nine patients both APAs and non-APAs. The positive predictive value of the most suspected APA, that is, the drainer that showed the highest aldosterone level by sAVS, was 11/11 (100%, 95% confidence interval [CI]: 71.5%–100%), while that for the second and third suspected APA was 3/7 (42.9%, 95% CI: 9.9%–81.6%), and they were significantly different (p =.01). Further, the positive predictive value of non-APA was 4/4 (100%, 95% CI: 39.8%–100%). Conclusions: The sAVS could correctly diagnose the aldosterone production in multiple ipsilateral adrenal nodules.
KW - adrenal glands
KW - adrenalectomy
KW - adrenocortical adenoma
KW - aldosterone
KW - endocrine glands
KW - hypertension
KW - primary aldosteronism
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U2 - 10.1111/cen.14858
DO - 10.1111/cen.14858
M3 - Article
C2 - 36471563
AN - SCOPUS:85144365129
SN - 0300-0664
VL - 98
SP - 487
EP - 495
JO - Clinical Endocrinology
JF - Clinical Endocrinology
IS - 4
ER -
