Document Detail

What is the best criterion for the interpretation of adrenal vein sample results in patients with primary hyperaldosteronism?
MedLine Citation:
PMID:  22048631     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: In patients with primary hyperaldosteronism, adrenal vein sampling (AVS) has emerged as a gold standard for distinguishing between unilateral and bilateral disease, but multiple criteria have been used and no consensus exists as to the most accurate criterion. The objective of this study was to determine which AVS criteria most accurately identify patients with unilateral surgical disease and are associated with significant clinical improvement after adrenalectomy.
METHODS: This is a retrospective analysis of AVS results in 108 patients with primary hyperaldosteronism treated at a single institution. Literature review of AVS criteria was used to distinguish between unilateral and bilateral disease.
RESULTS: Of the 10 AVS criteria identified in the literature, one criterion (ACTH stimulation, positioning: cortisol [adrenal]/cortisol [periphery] [Ca/Cp] > 5.0 and lateralization: aldosterone/cortisol [A/C] [dominant {D}]: A/C [nondominant {ND}] > 4:1) was the most accurate in identifying and correctly predicting lateralization of disease (P value range: < 0.001-0.0369). For this criterion, the true positive rate was 88%. The second most accurate criterion was no ACTH stimulation, positioning Ca/Cp > 1.1 and lateralization: A/C (D): A/C (ND) > 2:1. For this criterion, the overall true positive was 85%. However, we found no significant difference in clinical outcome based on individual criteria fulfillment.
CONCLUSIONS: Of the multiple criteria used for AVS evaluation, one criterion has the best accuracy. With the increasing use of AVS, there should be a consensus by which these results are evaluated and surgeons recommend adrenalectomy.
Richard Webb; Aarti Mathur; Richard Chang; Smita Baid; Naris Nilubol; Steven K Libutti; Constantine A Stratakis; Electron Kebebew
Publication Detail:
Type:  Journal Article     Date:  2011-11-03
Journal Detail:
Title:  Annals of surgical oncology     Volume:  19     ISSN:  1534-4681     ISO Abbreviation:  Ann. Surg. Oncol.     Publication Date:  2012 Jun 
Date Detail:
Created Date:  2012-05-21     Completed Date:  2012-10-09     Revised Date:  2014-05-29    
Medline Journal Info:
Nlm Unique ID:  9420840     Medline TA:  Ann Surg Oncol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1881-6     Citation Subset:  IM    
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms
Adrenal Glands / blood supply*,  pathology,  surgery
Biological Markers / blood*
Follow-Up Studies
Hyperaldosteronism / blood*,  diagnosis*,  surgery
Middle Aged
Retrospective Studies
Veins / metabolism*
Young Adult
Grant Support
Reg. No./Substance:
0/Biological Markers

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

Previous Document:  A Pathway-Based Approach to Identify Molecular Biomarkers in Cancer.
Next Document:  Diagnostic Value of Sentinel Lymph Node Biopsy in Gastric Cancer: A Meta-Analysis.