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Surgical outcomes of patients with primary aldosteronism lateralized with I‑131‑6 β‑iodomethyl‑norcholesterol single photon emission/computed tomography without discontinuation or modification of antihypertensive medications

Chia‑Hui Changa, Stephen Shei‑Dei Yangb, Yao‑Chou Tsaib, Shi‑Wen Kuoa, Shiou‑Chi Cherngc, Ching‑Chu Lud, Ruoh‑Fang Yend, Vin‑Cent Wue, Ya‑Hui Hua*

 

aDivision of Endocrinology and Metabolism, Department of Internal Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan, bDivision of Urology, Department of Surgery, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan, cDepartment of Nuclear Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan, dDepartment of Nuclear Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan, eDepartment of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan

 

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Open Access funded by Buddhist Compassion Relief Tzu Chi Foundation

 
 
Abstract

Objectives: Adrenocortical scintigraphy for patients with primary aldosteronism (PA) without discontinuation or modification of  antihypertensive medications is of concern because of drug interference with the renin–angiotensin–aldosterone system. We report
the surgical outcomes of patients with PA lateralized with adrenocortical scintigraphy without drug discontinuation or modification. Materials and Methods: We retrospectively reviewed 34 patients with PA with computed tomography (CT)‑documented adrenal tumors who had undergoing subsequent I‑131‑6 β‑iodomethyl‑norcholesterol (NP‑59) single photon emission CT (SPECT)/CT followed by unilateral adrenalectomy according to the results of NP‑59 uptake between May 2005 and December 2014. All enrolled patients underwent standard confirmatory tests and lateralization with NP‑59 SPECT/CT without discontinuation of existing antihypertensive medications, including spironolactone. The pathological findings, hypertension outcomes, and biochemical changes were reported. The accuracy of NP‑59 SPECT/CT without drug discontinuation or modification was also evaluated. Results: None of the 34 enrolled patients (M:F = 16:18) had complications such as a hypertensive crisis, life‑threatening hypokalemic event, or cardiac arrhythmia. Pathology disclosed 31 (91%) adenomas and three cases of hyperplasia. Hypertension cure and improvement were observed in 12 (35%) and 18 (53%) patients, respectively. All of the 30 patients (100%) without postoperative use of beta‑blockers and with an available postoperative aldosterone/renin ratio achieved a biochemical cure. The positive predictive values of NP‑59 SPECT/CT were 91%, 88%, and 100% for the pathological findings, hypertension outcomes, and biochemical changes, respectively. Conclusion: Noninvasive NP‑59 SPECT/CT without discontinuation or modification of antihypertensive medications not only provided accurate lateralization and safety but also resulted in a high improvement rate for PA‑associated hypertension.

Keywords: Adrenocortical scintigraphy, Drug discontinuation, I‑131‑6 β‑iodomethyl‑norcholesterol single photon emission computed tomography/computed tomography, Primary aldosteronism, Spironolactone 

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