Discordance between imaging and immunohistochemistry in unilateral primary aldosteronism
| Autor: | Aya T Nanba, James J. Shields, James Brian Byrd, Adina F. Turcu, Richard J. Auchus, Barbara S. Miller, Kazutaka Nanba, Thomas J. Giordano, William E. Rainey |
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| Rok vydání: | 2017 |
| Předmět: |
Adult
Male Aldosterone synthase medicine.medical_specialty Endocrinology Diabetes and Metabolism medicine.medical_treatment 030209 endocrinology & metabolism 030204 cardiovascular system & hematology Inferior vena cava Article 03 medical and health sciences chemistry.chemical_compound 0302 clinical medicine Endocrinology Primary aldosteronism Internal medicine Cosyntropin Adrenal Glands Hyperaldosteronism medicine Cytochrome P-450 CYP11B2 Humans Aged Retrospective Studies Aldosterone biology business.industry Adrenalectomy Steroid 17-alpha-Hydroxylase Retrospective cohort study Middle Aged medicine.disease Immunohistochemistry Surgery chemistry medicine.vein biology.protein Female business |
| Zdroj: | Clinical Endocrinology. 87:665-672 |
| ISSN: | 0300-0664 |
| Popis: | Objective Correct subtyping of primary aldosteronism (PA) is essential for good surgical outcomes. Adrenal vein sampling (AVS) and/or computed tomography (CT) are used for PA sub-classification. Clinical and/or biochemical improvement after surgery, however, is not always achieved in patients with presumed unilateral PA. We aimed to identify the pitfalls in PA sub-classification leading to surgical treatment failures. Patients and Design We retrospectively studied 208 patients who underwent adrenal vein sampling (AVS) for PA sub-classification in a tertiary referral centre, between January 2009 and August 2016. Simultaneous bilateral AVS was performed before and after cosyntropin administration. We implemented immunohistochemistry for aldosterone synthase (CYP11B2) and 17α-hydroxylase/17,20 lyase (CYP17A1) in adrenal glands resected from patients without improvement of PA after surgical treatment and from those with limitations in AVS interpretation. Results Of 55 patients who underwent adrenalectomy, three (5.5%) had no improvement of PA. All three patients underwent partial adrenalectomy to remove a CT-detected nodule present on the same side with AVS lateralization. Immunohistochemistry revealed a CYP11B2-negative nodule in both cases available. All patients who underwent total adrenalectomy based on AVS lateralization benefitted from surgery, including three patients with unilateral unsuccessful AVS and aldosterone suppression in the catheterized side vs. inferior vena cava. Conclusions Radiographically identified adrenal nodules are not always a source of PA, even when ipsilateral with AVS lateralization. These data caution against reliance on imaging findings, either alone or in conjunction with AVS, to guide surgery for PA. This article is protected by copyright. All rights reserved. |
| Databáze: | OpenAIRE |
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