Aldosterone suppression on contralateral adrenal during adrenal vein sampling does not predict blood pressure response after adrenalectomy

Silvia Monticone, Fumitoshi Satoh, Andrea Viola, Evelyn Fischer, Oliver Vonend, Giampaolo Bernini, Barbara Lucatello, Marcus Quinkler, Vanessa Ronconi, Ryo Morimoto, Masataka Kudo, Christoph Degenhart, Xing Gao, Davide Carrara, Holger S. Willenberg, Denis Rossato, Giulio Mengozzi, Anna Riester, Enrico Paci, Yoshitsugu IwakuraJacopo Burrello, Mauro Maccario, Gilberta Giacchetti, Franco Veglio, Sadayoshi Ito, Martin Reincke, Paolo Mulatero

Research output: Contribution to journalArticlepeer-review

52 Citations (Scopus)


Context: Adrenal vein sampling (AVS) is the only reliable means to distinguish between aldosterone-producing adenoma and bilateral adrenal hyperplasia, the two most common subtypes of primary aldosteronism (PA). AVS protocols are not standardized and vary widely between centers.

Setting: The study was carried out in eight different referral centers in Italy. Germany, and Japan.

Patients: From 585 consecutive AVS in patients with confirmed PA, 234 procedures met the inclusion criteria and were used for the subsequent analyses.

Objective: The objective of the study was to retrospectively investigate whether the presence of contralateral adrenal (CL) suppression of aldosterone secretion was associated with improved postoperative outcomes in patients who underwent unilateral adrenalectomy for PA.

Results: Overall, 82% of patients displayed contralateral suppression. This percentage was significantly higher in ACTH stimulated compared with basal procedures (90% vs 77%). The CL ratio was inversely correlated with the aldosterone level at diagnosis and, among AVS parameters, with the lateralization index (P= .02 and P= .01, respectively). The absence of contralateral suppression was not associated with a lower rate of response to adrenalectomy in terms of both clinical and biochemical parameters, and patients with CL suppression underwent a significantly larger reduction in the aldosterone levels after adrenalectomy.

Conclusions: For patients with lateralizing indices of greater than 4 (which comprised the great majority of subjects in this study), CL suppression should not be required to refer patients to adrenalectomy because it is not associated with a larger blood pressure reduction after surgery and might exclude patients from curative surgery.

Original languageEnglish
Pages (from-to)4158-4166
Number of pages9
JournalJournal of Clinical Endocrinology and Metabolism
Issue number11
Publication statusPublished - 2014 Nov 1

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism
  • Biochemistry
  • Endocrinology
  • Clinical Biochemistry
  • Biochemistry, medical


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