Surgical versus medical management of patients with primary hyperaldosteronism and indeterminate adrenal vein sampling: A 10‐year experience of the Cleveland Clinic

Autor: Chineme Onwubueke, Saif M Borgan, Huijun Xiao, Keren Zhou
Jazyk: angličtina
Rok vydání: 2024
Předmět:
Zdroj: The Journal of Clinical Hypertension, Vol 26, Iss 5, Pp 584-587 (2024)
Druh dokumentu: article
ISSN: 1751-7176
1524-6175
DOI: 10.1111/jch.14810
Popis: Abstract In patients with primary hyperaldosteronism (PA), adrenal vein sampling (AVS) can identify patients suitable for unilateral adrenalectomy. However, in AVS with an indeterminate aldosterone‐to‐cortisol lateralization (ACL) ratio of 3.0–4.0, clinical guidance is unclear. The authors screened all patients undergoing AVS at the Cleveland Clinic from October 2010 to January 2021 and identified 18 patients with indeterminate ACL results. Ten underwent adrenalectomy and eight continued medical management. The surgical group was younger (58.5 vs. 68 years, p = .17), and more likely to have a unilateral imaging adrenal abnormality (90% vs. 38%, p = .043) and a lower contralateral suppression index (0.63 vs. 1.1, p = .14). Post‐treatment, the surgical group had a significant reduction in diastolic blood pressure (–5.5 mmHg, p = .043) and aldosterone (4.40 vs. 35.80 ng/mL, p = .035) and required fewer anti‐hypertensive medications (2 vs. 3, p = .015). These findings may support the benefit of adrenalectomy in a select group of patients with indeterminate ACL.
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