Strategies for subtyping primary aldosteronism

Yun-Hsuan Yang; Yu-Ling Chang; Bo-Ching Lee; Ching-Chu Lu; Wei-Ting Wang; Ya-Hui Hu; Han-Wen Liu; Yung-Hsiang Lin; Chin-Chen Chang; Wan-Chen Wu; Fen-Yu Tseng; Yen-Hung Lin; Vin-Cent Wu; Chii-Min Hwu

doi:10.1016/j.jfma.2023.05.004

Strategies for subtyping primary aldosteronism

J Formos Med Assoc. 2024 Mar:123 Suppl 2:S114-S124. doi: 10.1016/j.jfma.2023.05.004. Epub 2023 May 17.

Authors

Yun-Hsuan Yang¹, Yu-Ling Chang¹, Bo-Ching Lee¹, Ching-Chu Lu², Wei-Ting Wang³, Ya-Hui Hu⁴, Han-Wen Liu⁵, Yung-Hsiang Lin⁶, Chin-Chen Chang⁷, Wan-Chen Wu⁸, Fen-Yu Tseng⁸, Yen-Hung Lin⁹, Vin-Cent Wu¹⁰, Chii-Min Hwu¹¹

Affiliations

¹ Department of Medical Imaging, National Taiwan University Hospital, National Taiwan University College of Medicine, Taiwan.
² Department of Nuclear Medicine, National Taiwan University Hospital, Taipei, Taiwan.
³ Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Faculty of Medicine, National Yang Ming Chiao Tung University School of Medicine, Taipei, Taiwan.
⁴ Division of Endocrinology and Metabolism, Department of Internal Medicine, Taipei Tzu Chi Hospital, The Buddhist Medical Foundation, Taipei, Taiwan.
⁵ Division of Endocrine and Metabolism, Taipei Medical University-Wan Fang Hospital, Taipei, Taiwan.
⁶ Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Puzi, Chia-Yi, Taiwan.
⁷ Department of Medical Imaging, National Taiwan University Hospital, National Taiwan University College of Medicine, Taiwan; Department and Graduate Institute of Forensic Medicine, National Taiwan University College of Medicine, Taipei, Taiwan. Electronic address: [email protected].
⁸ Division of Endocrinology & Metabolism, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
⁹ Division of Cardiology, Department of Internal Medicine and Cardiovascular Center, National Taiwan University Hospital, Taipei, Taiwan; Primary Aldosteronism Center at National Taiwan University Hospital, Taipei, Taiwan.
¹⁰ Primary Aldosteronism Center at National Taiwan University Hospital, Taipei, Taiwan; Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
¹¹ Faculty of Medicine, National Yang Ming Chiao Tung University School of Medicine, Taipei, Taiwan; Section of Endocrinology and Metabolism, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.

PMID: 37202237
DOI: 10.1016/j.jfma.2023.05.004

Abstract

Adrenal venous sampling (AVS) is a crucial method for the lateralization of primary aldosteronism (PA). It is advised to halt the use of the patient's antihypertensive medications and correct hypokalemia prior to undergoing AVS. Hospitals equipped to conduct AVS should establish their own diagnostic criteria based on current guidelines. If the patient's antihypertensive medications cannot be discontinued, AVS can be performed as long as the serum renin level is suppressed. The Task Force of Taiwan PA recommends using a combination of adrenocorticotropic hormone stimulation, quick cortisol assay, and C-arm cone-beam computed tomography to maximize the success of AVS and minimize errors by using the simultaneous sampling technique. If AVS is not successful, an NP-59 (131 I-6-β-iodomethyl-19-norcholesterol) scan can be used as an alternative method to lateralize PA. We depicted the details of the lateralization procedures (mainly AVS, and alternatively NP-59) and their tips and tricks for confirmed PA patients who would consider to undergo surgical treatment (unilateral adrenalectomy) if the subtyping shows unilateral disease.

Keywords: Adrenal hyperplasia; Adrenocortical adenoma; Aldosterone; Cortisol; Hyperaldosteronism.

Publication types

Review

MeSH terms

Adosterol
Adrenal Glands*
Aldosterone
Antihypertensive Agents
Humans
Hyperaldosteronism* / diagnosis
Hyperaldosteronism* / surgery
Retrospective Studies

Substances

Aldosterone
Antihypertensive Agents
Adosterol