Adrenal Vein Sampling Results and Surgical Outcomes in Patients with Non-suppressed Plasma Renin Activity.

PURPOSE: To determine adrenal vein sampling (AVS) and post-adrenalectomy outcomes in patients with a non-suppressed plasma renin activity (PRA) and elevated aldosterone-to-renin ratio (ARR).

MATERIALS AND METHODS: The study sample included 23 patients with an ARR > 20 and PRA > 1 ng/mL/h ("non-suppressed group") and 69 patients with an ARR > 20 and PRA < 0.6 ng/ml/h ("suppressed group") who underwent AVS from 2006-2023. Data regarding baseline clinical characteristics, AVS results, and outcomes after adrenalectomy were analyzed.

RESULTS: The proportion of patients in the non-suppressed group who had a lateralization index > 4 was lower than that in the suppressed group, although this was non-significant (43% vs. 62%, p = 0.15). The mean lateralization index in the non-suppressed group was lower compared to the suppressed group (8.7 vs. 17.4, p = 0.05). The proportion of patients in the non-suppressed group with improved or cured hypertension following adrenalectomy was similar to that of patients in the suppressed group who also underwent surgery (6/8, 75% vs. 25/32, 78%, p = 0.71). All hypokalemic patients (32/32) who underwent adrenalectomy had normalization of their potassium levels following surgery.

CONCLUSION: Nearly half of patients with non-suppressed PRA lateralized with AVS. The patients who did lateralize had similar blood pressure response and correction of hypokalemia following adrenalectomy, regardless of PRA. Therefore, patients with a non-suppressed PRA (greater than 1 ng/ml/h) should still be considered for AVS provided the ARR is elevated.