We sought to measure the clinical benefits of adrenal venous sampling (AVS), a test recommended by guidelines for primary aldosteronism (PA) patients seeking surgical cure, in a large registry of PA patients submitted to AVS. Data of 1625 consecutive patients submitted to AVS in 19 tertiary referral centers located in Asia, Australia, Europe, and North America were collected in a large multicenter international registry. The primary end points were the rate of bilateral success, ascertained lateralization of PA, adrenalectomy, and of cured arterial hypertension among AVS-guided and non AVS-guided adrenalectomy patients. AVS was successful in 80.1% of all cases but allowed identification of unilateral PA in only 45.5% by the criteria in use at each center. Adrenalectomy was performed in 41.8% of all patients and cured arterial hypertension in 19.6% of the patients, 2-fold more frequently in women than men (P<0.001). When AVS-guided, surgery provided a higher rate of cure of hypertension than when non-AVS-guided (40.0% versus 30.5%; P=0.027). Compared with surgical cases, patients treated medically needed more antihypertensive medications (P<0.001) and exhibited a higher rate of persistent hypokalemia requiring potassium supplementation (4.9% versus 2.3%; P<0.01). The low rate of adrenalectomy and cure of hypertension in PA patients seeking surgical cure indicates suboptimal AVS use, possibly related to issues in patient selection, technical success, and AVS data interpretation. Given the better outcomes of AVS-guided adrenalectomy, these results call for actions to improve the diagnostic use of this test that is necessary for detection of surgical PA candidates. Clinical Trial Registration- URL: http://www.clinicaltrials.gov. Unique identifier: NCT01234220.

3rd Department of Medicine Charles University Prague General Hospital Czech Republic

AP HP Hôpital Européen Georges Pompidou Hypertension Unit Paris France

Department of Diabetes Endocrinology and Metabolism National Center for Global Health and Medicine

Department of Endocrinology National Hospital Organization Kyoto Medical Center Clinical Research Institute Japan

Department of Endocrinology North Western State Medical University named after 1 I Mechnikov St Petersburg Russia

Department of Internal Medicine

Department of Internal Medicine Azienda Unità Sanitaria Locale IRCCS Arcispedale S Maria Nuova Hypertension Unit Reggio Emilia Italy

Department of Internal Medicine National Taiwan University Hospital Taipei

Department of Medical Imaging National Taiwan University Hospital Taipei

Department of Nephrology Hypertension Unit Hosp del Mar Universitat Autònoma de Barcelona Spain

Department of Nephrology Tohoku University Hospital Endocrinology and Vascular Medicine Sendai

Division of Endocrinology and Metabolism Rostock University Medical Center Germany

Endocrinology in Charlottenburg Berlin Germany

Endocrinology Unit Monash Health Clayton VIC Australia

Faculty of Medicine Université de Paris INSERM UMR970 Paris Cardiovascular Research Center France

Foothills Medical Centre University of Calgary Canada

From the Department of Medicine DIMED University of Padova Hypertension Unit University Hospital Padova Italy

Heinrich Heine University Düsseldorf Nephrologie Germany

INSERM CIC1418 F 75015 Paris France

Institute of Cardiovascular and Medical Sciences University of Glasgow United Kingdom

Institute of Radiology University of Padova Italy

Medical College of Wisconsin Endocrinology Center North Hills Health Center Menomonee Falls

Medizinische Klinik und Poliklinik 4 Klinikum der Universität München LMU München

Radboud University Medical Center Nijmegen Netherlands

Radiology

University Medical Centre Ljubljana

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Subtype Identification of Surgically Curable Primary Aldosteronism During Treatment With Mineralocorticoid Receptor Blockade

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ClinicalTrials.gov
NCT01234220