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학술저널
저자정보
양예슬 ((학) 가톨릭학원의정부성모병원) 이승훈 (서울아산병원) 김정희 (서울대학교병원) 유지희 (성균관대학교) 이정현 (서울대학교) 이서영 (Department of Internal Medicine, Mediplex Sejong Hospital, Korea) 홍아람 (Department of Internal Medicine, Chonnam National University, Korea) 이동화 (충북대학교병원) 고정민 (서울아산병원) 김재현 (삼성서울병원) 김상완 (서울대학교)
저널정보
대한내분비학회 Endocrinology and Metabolism Endocrinology and Metabolism Vol.36 No.4
발행연도
2021.8
수록면
875 - 884 (10page)
DOI
https://doi.org/10.3803/EnM.2021.1047

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Background: Adrenal venous sampling (AVS) is performed to distinguish the subtype of primary aldosteronism (PA). The clinicalimplication of contralateral suppression (CS; aldosterone/cortisolnondominant<aldosterone/cortisolperipheral) at AVS remains unclear. Weaimed to investigate the clinical significance of CS and its impact on postoperative outcomes after unilateral adrenalectomy. Methods: In this retrospective observational multi-center study, we analyzed PA patients who underwent both successful adrenocorticotropin hormone-stimulated AVS and unilateral adrenalectomy. Successful cannulation was defined as the selectivity index (cortisoladrenal/cortisolperipheral) ≥3. Clinical and biochemical outcomes after unilateral adrenalectomy were evaluated based on the international Primary Aldosteronism Surgical Outcome consensus. Results: Among 263 patients analyzed, 247 had CS (93.9%). Patients with CS had lower serum potassium levels, higher plasma aldosterone concentration, higher aldosterone-to-renin ratio (ARR), and larger adenoma size than those without CS. Those with CSshowed significantly higher lateralization index than those without CS (P<0.001). Although postoperative blood pressure and ARRsignificantly decreased in those with CS, clinical and biochemical outcomes were comparable in both groups. When the cut-off valueof age was determined using receiver operating characteristic (ROC) analysis, patients aged ≥50 years old with contralateral suppression index (CSI; the ratio between aldosterone/cortisolnondominant and aldosterone/cortisolperipheral) ≤0.26 had greater odds ratio(6.43; 95% confidence interval, 1.30 to 31.69) of incident chronic kidney disease than those aged <50 years with CSI >0.26 afteradjusting for other factors. Conclusion: CS may not predict postoperative clinical and biochemical outcomes in subjects with unilateral aldosterone excess, butit is associated with postsurgical deterioration of renal function in subjects over 50 years with CSI ≤0.26.

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