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. 2020 Jun 1;105(6):dgz017.
doi: 10.1210/clinem/dgz017.

Subtyping of Primary Aldosteronism in the AVIS-2 Study: Assessment of Selectivity and Lateralization

Giacomo Rossitto  1   2 , Laurence Amar  3 , Michel Azizi  3 , Anna Riester  4 , Martin Reincke  4 , Christoph Degenhart  4 , Jiri Widimsky  5 , Mitsuhide Naruse  6 , Jaap Deinum  7 , Leo Schultzekool  7 , Tomaz Kocjan  8 , Aurelio Negro  9 , Ermanno Rossi  9 , Gregory Kline  10 , Akiyo Tanabe  11 , Fumitoshi Satoh  12 , Lars Christian Rump  13 , Oliver Vonend  13 , Holger S Willenberg  14 , Peter Fuller  15 , Jun Yang  15 , Nicholas Yong Nian Chee  15 , Steven B Magill  16 , Zulfiya Shafigullina  17 , Marcus Quinkler  18 , Anna Oliveras  19 , Chin-Chen Chang  20 , Vin Cent Wu  20 , Zusana Somloova  5 , Giuseppe Maiolino  1 , Giulio Barbiero  21 , Michele Battistel  21 , Livia Lenzini  1 , Emilio Quaia  21 , Achille Cesare Pessina  1 , Gian Paolo Rossi  1
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Free article

Subtyping of Primary Aldosteronism in the AVIS-2 Study: Assessment of Selectivity and Lateralization

Giacomo Rossitto et al. J Clin Endocrinol Metab. .
Free article

Abstract

Context: Adrenal venous sampling (AVS) is the key test for subtyping primary aldosteronism (PA), but its interpretation varies widely across referral centers and this can adversely affect the management of PA patients.

Objectives: To investigate in a real-life study the rate of bilateral success and identification of unilateral aldosteronism and their impact on blood pressure outcomes in PA subtyped by AVS.

Design and settings: In a retrospective analysis of the largest international registry of individual AVS data (AVIS-2 study), we investigated how different cut-off values of the selectivity index (SI) and lateralization index (LI) affected rate of bilateral success, identification of unilateral aldosteronism, and blood pressure outcomes.

Results: AVIS-2 recruited 1625 individual AVS studies performed between 2000 and 2015 in 19 tertiary referral centers. Under unstimulated conditions, the rate of biochemically confirmed bilateral AVS success progressively decreased with increasing SI cut-offs; furthermore, with currently used LI cut-offs, the rate of identified unilateral PA leading to adrenalectomy was as low as <25%. A within-patient pairwise comparison of 402 AVS performed both under unstimulated and cosyntropin-stimulated conditions showed that cosyntropin increased the confirmed rate of bilateral selectivity for SI cut-offs ≥ 2.0, but reduced lateralization rates (P < 0.001). Post-adrenalectomy outcomes were not improved by use of cosyntropin or more restrictive diagnostic criteria.

Conclusion: Commonly used SI and LI cut-offs are associated with disappointingly low rates of biochemically defined AVS success and identified unilateral PA. Evidence-based protocols entailing less restrictive interpretative cut-offs might optimize the clinical use of this costly and invasive test. (J Clin Endocrinol Metab XX: 0-0, 2020).

Trial registration: ClinicalTrials.gov NCT01234220.

Keywords: adrenal vein sampling; aldosterone; aldosteronism; diagnosis; registry.

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