Surgical versus medical management of patients with primary hyperaldosteronism and indeterminate adrenal vein sampling: A 10‐year experience of the Cleveland Clinic

• DOI: 10.1111/jch.14810
• Publication Date: 2024-04-12T06:08:47Z
• Authors: Chineme Onwubueke; Saif M Borgan; Huijun Xiao; Keren Zhou
• Keywords: Male; Hydrocortisone; aldosterone excess; Blood Pressure; Veins; treatment and diagnosis/guidelines; 03 medical and health sciences; 0302 clinical medicine; Hyperaldosteronism; Adrenal Glands; Diseases of the circulatory (Cardiovascular) system; Short Research Article; Humans; outcomes of care; Aldosterone; Antihypertensive Agents; Aged; Retrospective Studies; Ohio; Adrenalectomy; Middle Aged; Treatment Outcome; secondary high blood pressure (HBP); RC666-701; Hypertension; Female

AbstractIn patients with primary hyperaldosteronism (PA), adrenal vein sampling (AVS) can identify patients suitable for unilateral adrenalectomy. However, in AVS with an indeterminate aldosterone‐to‐cortisol lateralization (ACL) ratio of 3.0–4.0, clinical guidance is unclear. The authors screened all patients undergoing AVS at the Cleveland Clinic from October 2010 to January 2021 and identified 18 patients with indeterminate ACL results. Ten underwent adrenalectomy and eight continued medical management. The surgical group was younger (58.5 vs. 68 years, p = .17), and more likely to have a unilateral imaging adrenal abnormality (90% vs. 38%, p = .043) and a lower contralateral suppression index (0.63 vs. 1.1, p = .14). Post‐treatment, the surgical group had a significant reduction in diastolic blood pressure (–5.5 mmHg, p = .043) and aldosterone (4.40 vs. 35.80 ng/mL, p = .035) and required fewer anti‐hypertensive medications (2 vs. 3, p = .015). These findings may support the benefit of adrenalectomy in a select group of patients with indeterminate ACL.