Optimal Determination Of Surgically Remediable Aldosteronism Requires Duplicate Measurements During Bilateral Adrenal Venous Sampling

You have accessJournal of UrologyAdrenal (PD07)1 Sep 2021PD07-03 OPTIMAL DETERMINATION OF SURGICALLY REMEDIABLE ALDOSTERONISM REQUIRES DUPLICATE MEASUREMENTS DURING BILATERAL ADRENAL VENOUS SAMPLING Srinath-Reddi Pingle, Benjamin Ristau, Tarunya Vedere, Charan Singh, Steven Shichman, and Carl Malchoff Srinath-Reddi PingleSrinath-Reddi Pingle More articles by this author , Benjamin RistauBenjamin Ristau More articles by this author , Tarunya VedereTarunya Vedere More articles by this author , Charan SinghCharan Singh More articles by this author , Steven ShichmanSteven Shichman More articles by this author , and Carl MalchoffCarl Malchoff More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001975.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Simultaneous bilateral adrenal vein sampling (AVS) is the standard for determining surgically remediable aldosteronism (SRA). The lateralization index (LI) is calculated by dividing the dominant aldosterone/cortisol ratio by the nondominant aldosterone/cortisol ratio. A ratio >4 is considered diagnostic of SRA. Variability in laboratory measurement may alter LI leading to inaccurate recommendations either for or against surgery. To mitigate this potential error, we draw duplicate samples in both pre- and post-adrenocorticotropic hormone (ACTH) stimulation settings. We used these duplicate measurements to understand LI variability and its impact on predicting SRA. METHODS: We performed a retrospective review of patients who underwent AVS for primary aldosteronism at a single institution from March 1999-January 2020. AVS was performed by obtaining an aldosterone/cortisol ratio at two time points both pre-ACTH and post-ACTH stimulation. The mean LI of the two duplicates in each setting was calculated. SRA was defined as a mean LI > 4 in either the pre- or post-ACTH setting. To determine percent variability, the second LI was subtracted from the first LI and the difference divided by the smallest LI. To determine if the differences in the duplicates were clinically significant (i.e. resulted in changing the diagnosis), we calculated the percent of patients in whom the duplicate measurements fell on opposite sides of the LI = 4 cutoff. RESULTS: 79 patients underwent AVS (Median age: 56y, IQR 50-62; Median serum aldosterone: 32 ng/dl; IQR 22.9-62.3; Median ARR: 224, IQR 94.3-456); 64 patients had duplicate pre-ACTH measurements and 75 patients had duplicate post-ACTH measurements. Of these, the median LI difference between the 1st and 2nd measurements was 0.125 (IQR -1.51-1.73) in the pre-ACTH setting and 0.9 (IQR -1.33-1.51) in the post-ACTH setting. The mean percent variability pre-ACTH was 75 ± 91 % and post-ACTH was 57 ± 76%. Using LI>4 as a cutoff, 14% of patients had discordant results between duplicate samples on pre-ACTH stimulation. 10.7% of patients had discordant results on post-ACTH stimulation. CONCLUSIONS: Duplicate sampling results differ by >50% in both pre- and post-ACTH sampling underscoring the importance of obtaining more than 1 value. The clinically significant variability, defined as discordant prediction of SRA within duplicate samples, is lower, but still exceeds 10% in both cases. The most accurate prediction of SRA requires performing duplicate sampling in both pre- and post-ACTH settings. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e105-e106 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Srinath-Reddi Pingle More articles by this author Benjamin Ristau More articles by this author Tarunya Vedere More articles by this author Charan Singh More articles by this author Steven Shichman More articles by this author Carl Malchoff More articles by this author Expand All Advertisement Loading ...