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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 12/2021

01-11-2021 | Adrenalectomy | Endocrine Tumors

Contralateral Suppression Index Does Not Predict Clinical Cure in Patients Undergoing Surgery for Primary Aldosteronism

Authors: Dana A. Dominguez, MD, Praveen Chatani, MD, Ryan Murphy, BS, Amy R. Copeland, MD, Richard Chang, MD, Samira M. Sadowski, MD, Fady Hannah-Shmouni, MD, Constantine A. Stratakis, MD, Naris Nilubol

Published in: Annals of Surgical Oncology | Issue 12/2021

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Abstract

Background

Adrenal venous sampling (AVS) is recommended before adrenalectomy for patients with primary aldosteronism (PA) over 35 years old. The literature examining contralateral suppression (CoS) on AVS in predicting surgical outcomes is conflicting. We examined the presence of CoS in patients who underwent adrenalectomy while adjusting for clinical and biochemical factors associated with a clinical cure of hypertension (ccHTN).

Methods

We performed a retrospective review of patients with successful AVS who underwent unilateral adrenalectomy for PA at a quaternary referral center. Patients were excluded if they had overt cortisol co-secretion, or inadequate follow-up. We first evaluated the aldosterone resolution score (ARS) in predicting ccHTN in our cohort. Next, the receiver-operator characteristic analysis (ROC) was used to determine the optimal contralateral suppression index (CSI) cutoff to define CoS. We performed univariable and multivariable analyses of factors associated with ccHTN. The primary outcome was ccHTN defined as blood pressure less than 140/90 mmHg, and off blood pressure medications.

Results

Of the 102 patients on bivariable analysis, age, sex, duration of HTN, number of medications, preoperative systolic blood pressure, and creatinine level were associated with ccHTN. ROC analysis of ARS had an AUC of 0.850 (p < 0.001). On multivariable analysis, only ARS remained associated with ccHTN (OR 3.40, 95% CI 1.20–9.61, p = 0.021). CSI was not significantly associated with ccHTN on ROC, bivariable, or multivariable analyses.

Conclusion

The presence of CoS was not useful in predicting ccHTN following unilateral adrenalectomy for PA in our cohort. After adjusting for clinical and biochemical factors, ARS remains a useful predictor for ccHTN.
Footnotes
1
Contralateral suppression index = [Aldosterone/CortisolNon-Dominant/Aldosterone/CortisolIliac]
 
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Metadata
Title
Contralateral Suppression Index Does Not Predict Clinical Cure in Patients Undergoing Surgery for Primary Aldosteronism
Authors
Dana A. Dominguez, MD
Praveen Chatani, MD
Ryan Murphy, BS
Amy R. Copeland, MD
Richard Chang, MD
Samira M. Sadowski, MD
Fady Hannah-Shmouni, MD
Constantine A. Stratakis, MD
Naris Nilubol
Publication date
01-11-2021
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 12/2021
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-021-09692-7

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