Abstract
Purpose
To test the efficacy of a strategy based on CT imaging and clinical characteristics on lateralizing origin of excess aldosterone secretion in primary aldosteronism.
Patients and methods
Consecutive patients with diagnosed primary hyperaldosteronism from June 2006 to July 2012 in our center underwent adrenal surgeries without pre-operational adrenal venous sampling (AVS) if all the three criteria were met: (1) round- or oval-shaped occupational lesion of low density after contrast enhancement with diameter >1 cm on CT scan was located in one adrenal gland; (2) unequivocally normal contralateral adrenal gland; (3) serum potassium level lower than 3.5 mmol/L. Subjects who had received operation were taken into analysis and follow-ups.
Results
One hundred and twenty-five patients fulfilled the criteria and were recruited into our research. One hundred and twenty-two operated patients (97.6%) experienced complete resolution of hypokalemia as well as resolution or improvement in hypertension with reduction in antihypertensive medication, while 3 patients (2.4%) failed to obtain normal kalemia and continued on spironolactone therapy. At a median of 65-month (range 21–93) follow-up of these 122 subjects, 27 patients dropped out (22.1%). The 95 responding patients reported no episodes of paralysis or confirmed hypokalemia or any supplementation of potassium. Multivariate linear correlation analysis showed that plasma potassium level was correlated inversely with tumor diameter (r = −0.258, 95% CI −0.076, −0.514, p = 0.037) and basal plasma aldosterone level (r = −0.251, 95% CI −0.040, −0.464, p = 0.042).
Conclusions
Most patients with typical unilateral adrenal macroadenomas, normal contralateral glands and hypokalemia could attain favorable surgical therapeutic outcomes without pre-operational AVS lateralization.
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Abbreviations
- PA:
-
Primary aldosteronism
- APA:
-
Aldosterone-producing adenoma
- AVS:
-
Adrenal venous sampling
- CT:
-
Computed tomography
- PAC:
-
Plasma aldosterone concentration
- PRA:
-
Plasma renin activity
- ARR:
-
Aldosterone–renin ratio
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Acknowledgements
We would like to thank all the doctors, nurses, technicians and patients involved for their dedication to the study. This study was supported by National Key Clinical Specialty Discipline Construction Program of China.
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HL and JL contributed to the present paper equally. HL and JL contributed to protocol/project development, data analysis, manuscript writing. XF, LL, GW and XC helped with data collection. YL contributed to protocol/project development, data analysis, manuscript editing.
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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.
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Informed consent was obtained from all individual participants included in the study.
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Li, H., Liu, J., Feng, X. et al. Favorable surgical outcomes of aldosterone-producing adenoma based on lateralization by CT imaging and hypokalemia: a non-AVS-based strategy. Int Urol Nephrol 49, 2151–2156 (2017). https://doi.org/10.1007/s11255-017-1705-9
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DOI: https://doi.org/10.1007/s11255-017-1705-9