Bilateral Disease Is a Predominant Subtype of Primary Aldosteronism: Advancing Care of Primary Aldosteronism in Japan Study (JPAS)

Presentation Number: SUN 523
Date of Presentation: April 2nd, 2017

Mitsuhide Naruse*1, Hironobu Umakoshi1, Hiroshi Ito2, Yoshiyu Takeda3, Takamasa Ichijo4, Norio Wada5, Takuyuki Katabami6, Yoshihiro Ogawa7, Katsutoshi Takahashi8, Nobuya Inagaki9, Junji Kawashima10, Hirotaka Shibata11, Toshihiko Yanase12, Hiromi Rakugi13, Kohei Kamemura14, Yuichi Fujii15, Masanobu Yamada16, Ryuichi Sakamoto17, Mika Tsuiki1, Tomoko Suzuki18, Takashi Kawamura19 and Jpas Group20
1National Hospital Organization Kyoto Medical Center, Kyoto, Japan, 2Keio University School of Medicine, 3Kanazawa University, Ishikawa, Japan, 4Saiseikai Yokohamashi Tobu Hospital, Yokohama, Japan, 5Sapporo City General Hospital, Sapporo, Japan, 6St Marianna University School of Medicine, Yokohama City Seibu Hospital, Yokohama-shi Kanagawa, Japan, 7Tokyo Medical and Dental University, Tokyo, Japan, 8University of Tokyo Hospital, Tokyo, Japan, 9Kyoto University Graduate School of Medicine, Kyoto, Japan, 10Kumamoto University, Kumamoto, Japan, 11Oita University, Yufu-city, Japan, 12Fukuoka University, Fukuoka, Japan, 13Osaka University, Osaka, Japan, 14Akashi Medical Center, Akashi, Japan, 15Hiroshima General Hospital of West Japan Railway Company, Hiroshima, Japan, 16Gunma University, Graduate School of Medicine, Japan, 17Kyushu Medical Center, Fukuoka, Japan, 18Kitasato University, 19Kyoto University, 20National Hospital Organization Kyoto Medical Center

Abstract

Primary aldosteronism (PA) is the most common form of curable endocrine hypertension, accounting for approximately 5 to 10% of the hypertensive patients. Accurate subtype diagnosis of PA is important in indicating unilateral subtype for surgery and bilateral subtype for medical therapy. Since the Endocrine Society Clinical Guideline recommended to perform adrenal venous sampling (AVS) for subtype diagnosis principally in all patients prior to surgery, percentage of each subtype has an impact on the clinical practice of PA. Although unilateral subtype has been reported to be the dominant subtype, most of the reports were from a single center and/or small sample size which could be associated with a large selection bias. Aim: To elucidate the percentage of each subtype of PA in Japan. Methods: We have established the nation-wide multicenter Cohort of PA by 24 referral centers (12 university hospitals,12 city hospitals) termed as JPAS (Japan Primary Aldosteronism Study). Patients who were diagnosed as PA by a positive case detection and at least one positive confirmatory testing and underwent AVS between Jan 2006 and June 2016 were enrolled. Subtype diagnosis of PA was determined by the AVS. Success of catheterization was assessed by the selectivity index greater than 5 and unilateral subtype of PA was defined if the lateralization index was greater than 4 after cosyntropin administration. Total 1500 patients with data of successful AVS after cosyntropin administration were analyzed in this study. The study was approved by the ethics committee of Kyoto Medical Center and individual centers and conducted according to the Guideline for Clinical Study in Japan. Results: Median age was 54 yrs. and median duration of hypertension was 6 years. Prevalence of hypokalemia before potassium supplementation was approximately 40%. Median PAC was 179 pg/ml and PRA was 0.4 ng/ml/h with a median ARR of 518. Adrenal nodule lager than 10mm in diameter was seen in 43% on CT. The percentage of unilateral subtype of PA showed a wide variation between centers, ranging from 13.9% to 56.2%. The overall average percentage of the unilateral subtype and bilateral subtype of PA was 31.3 % and 68.7%, respectively. There was no significant relationship between the percentage of the unilateral subtype and the number of AVS performed in each center. There was however a significant correlation between the percentage of the unilateral subtype and the prevalence of hypokalemia. Conclusions: We have established the multicenter database of PA in Japan (JPAS). There was a large variation between centers in the percentage of each subtype of PA. Given the bilateral subtype as the predominant subtype accounting for 70% of PA in Japan, strict indication of AVS and establishing appropriate medical therapy are warranted.(Supported by AMED:15Aek0109122)

 

Disclosure: TK: Protocol review committee, ONO-Pharma, Investigator, ONO-Pharma. MY: Investigator, ONO-Pharma. MT: Investigator, ONO-Pharma. Nothing to Disclose: MN, HU, HI, YT, TI, NW, YO, KT, NI, JK, HS, TY, HR, KK, YF, RS, TS, TK, JG