Abstract Objectives The aim of this study was to investigate the impact of adrenal venous sampling (AVS) lateralization cut-offs on surgical outcomes. Patients and Methods Cosyntropin-stimulated AVS was used to guide surgical management of 377 patients with primary aldosteronism (PA) who were evaluated 6 months after surgery. Main outcome measures The proportion of patients that achieved clinical benefit and complete biochemical success based on the AVS aldosterone lateralization index (LI) was determined. Results Clinical benefit was achieved in 29 of 47 patients with an LI between 2-4, in 66 of 101 with an LI between 4-10, and in 158 of 203 with an LI >10 (P<0.01 for trend). Complete biochemical success was achieved in 27 of 42 with an LI between 2–4, in 60 of 76 with an LI between 4-10, and in 127 of 155 with an LI >10 (P=0.024 for trend). After adjustment for confounders and using those with an LI between 2–4 as a reference, a clinical benefit was associated only with those with an LI >10 (OR 2.30; 95%CI 1.03–5.16); whereas, complete biochemical success was associated with those with an LI between 4–10 (OR 2.83; 95%CI 1.14–7.01) or LI >10 (OR 3.55, 95%CI 1.47–8.55). Conclusions Difference of clinical outcome was relatively small when strict LI diagnostic threshold was used and biochemical cure was sufficiently achieved when an LI >4 was used. Our study by standardized outcome measure validated that an LI >4 is suggest to be appropriate to determine unilateral disease in PA. Copyright © 2018 Endocrine Society This article has been published under the terms of the Creative Commons Attribution Non-Commercial, No-Derivatives License (CC BY-NC-ND; https://creativecommons.org/licenses/by-nc-nd/4.0/).
Journal of the Endocrine Society – Oxford University Press
Published: May 24, 2018
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