Key result
Noninvasive NP-59 SPECT/CT without discontinuation of antihypertensive medications provided accurate lateralization, yielding an 88% positive predictive value for hypertension cure or improvement and a 100% biochemical cure rate.
Why the study?
Does NP-59 SPECT/CT lateralization without discontinuation of antihypertensive medications accurately predict surgical outcomes in patients with primary aldosteronism?
Observational (n=34)
No
Does NP-59 SPECT/CT lateralization without discontinuation of antihypertensive medications accurately predict surgical outcomes in patients with primary aldosteronism?
NP-59 SPECT/CT without discontinuing antihypertensive medications provides accurate lateralization and safe surgical outcomes for patients with primary aldosteronism.
Answers are grounded in this paper and cite their sources.
NP-59 SPECT/CT may support lateralization without medication discontinuation in primary aldosteronism; observational data leave open need for randomized validation.
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.
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Chang et al. (2018) conducted an observational in Primary aldosteronism (n=34). NP-59 SPECT/CT without discontinuation of antihypertensive medications was evaluated on Positive predictive value for hypertension outcomes (cure or improvement). Noninvasive NP-59 SPECT/CT without discontinuation of antihypertensive medications provided accurate lateralization, yielding an 88% positive predictive value for hypertension cure or improvement and a 100% biochemical cure rate.
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