{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,2]],"date-time":"2026-01-02T07:47:50Z","timestamp":1767340070453,"version":"3.41.2"},"reference-count":33,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2021,4,12]],"date-time":"2021-04-12T00:00:00Z","timestamp":1618185600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100009619","name":"Japan Agency for Medical Research and Development","doi-asserted-by":"publisher","award":["JP17ek0109122, JP20ek0109352"],"award-info":[{"award-number":["JP17ek0109122, JP20ek0109352"]}],"id":[{"id":"10.13039\/100009619","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100012319","name":"National Center for Global Health and Medicine","doi-asserted-by":"publisher","award":["27-1402, 30-1008"],"award-info":[{"award-number":["27-1402, 30-1008"]}],"id":[{"id":"10.13039\/100012319","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100008903","name":"Ministry of Health and Welfare","doi-asserted-by":"publisher","award":["Nanbyo-Ippan-046"],"award-info":[{"award-number":["Nanbyo-Ippan-046"]}],"id":[{"id":"10.13039\/100008903","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004330","name":"Smoking Research Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100004330","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Endocrinol."],"abstract":"<jats:sec><jats:title>Introduction<\/jats:title><jats:p>Some aldosterone-producing micro-adenomas cannot be detected through image inspection. Therefore, adrenal venous sampling (AVS) is often performed, even in primary aldosteronism (PA) patients who have no apparent adrenal tumors (ATs) on imaging. In most of these cases, however, the PA is bilateral.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objective<\/jats:title><jats:p>To clarify the clinical need for AVS in PA patients without apparent ATs, taking into consideration the rates of adrenalectomy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This is a retrospective cross-sectional study assessing 1586 PA patients without apparent ATs in the multicenter Japan PA study (JPAS). We analyzed which parameters could be used to distinguish unilateral PA patients without apparent ATs from bilateral patients. We also analyzed the prevalences of adrenalectomy in unilateral PA patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The unilateral subtype without an apparent AT was diagnosed in 200 (12.6%) of 1586 PA patients. Being young and female with a short hypertension duration, normokalemia, low creatinine level, low plasma aldosterone concentration, and low aldosterone-to-renin ratio (ARR) was significantly more common in bilateral than unilateral PA patients. If PA patients without apparent ATs were female and normokalemic with a low ARR (&amp;lt;560 pg\/ml per ng\/ml\/h), the rate of unilateral PA was only 5 (1.1%) out of 444. Moreover, 77 (38.5%) of the 200 did not receive adrenalectomy, despite being diagnosed with the unilateral subtype based on AVS.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The low prevalence of the unilateral subtype in PA patients without apparent ATs suggests AVS is not indicated for all of these patients. AVS could be skipped in female normokalemic PA patients without apparent ATs if their ARRs are not high. However, AVS should be considered for male hypokalemic PA patients with high ARRs because the rates of the unilateral subtype are high in these patients.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fendo.2021.645395","type":"journal-article","created":{"date-parts":[[2021,4,12]],"date-time":"2021-04-12T07:47:46Z","timestamp":1618213666000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":5,"title":["Should Adrenal Venous Sampling Be Performed in PA Patients Without Apparent Adrenal Tumors?"],"prefix":"10.3389","volume":"12","author":[{"given":"Kentaro","family":"Okamoto","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Youichi","family":"Ohno","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Masakatsu","family":"Sone","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nobuya","family":"Inagaki","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Takamasa","family":"Ichijo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Takashi","family":"Yoneda","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mika","family":"Tsuiki","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Norio","family":"Wada","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kenji","family":"Oki","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kouichi","family":"Tamura","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hiroki","family":"Kobayashi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shoichiro","family":"Izawa","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Akiyo","family":"Tanabe","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mitsuhide","family":"Naruse","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2021,4,12]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2016-1472","article-title":"Study Heterogeneity and Estimation of Prevalence of Primary Aldosteronism: A Systematic Review and Meta-Regression Analysis","volume":"101","author":"K\u00e4yser","year":"2016","journal-title":"J Clin Endocrinol Metab"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.3109\/07853890.2013.785234","article-title":"Diagnosis and management of primary aldosteronism: an updated review","volume":"45","author":"Chao","year":"2013","journal-title":"Ann Med"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1038\/nrneph.2013.110","article-title":"Contribution of aldosterone to cardiovascular and renal inflammation and fibrosis","volume":"9","author":"Brown","year":"2013","journal-title":"Nat Rev Nephrol"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1161\/HYPERTENSIONAHA.117.10263","article-title":"Prevalence of Cardiovascular Disease and Its Risk Factors in Primary Aldosteronism: A Multicenter Study in Japan","volume":"71","author":"Ohno","year":"2018","journal-title":"Hypertension"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-151-5-200909010-00007","article-title":"Systematic review: diagnostic procedures to differentiate unilateral from bilateral adrenal abnormality in primary aldosteronism","volume":"151","author":"Kempers","year":"2009","journal-title":"Ann Intern Med"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1016\/j.surg.2004.06.051","article-title":"Role for adrenal venous sampling in primary aldosteronism","volume":"136","author":"Young","year":"2004","journal-title":"Surgery"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2011-2830","article-title":"The Adrenal Vein Sampling International Study (AVIS) for identifying the major subtypes of primary aldosteronism","volume":"97","author":"Rossi","year":"2012","journal-title":"J Clin Endocrinol Metab"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1161\/HYPERTENSIONAHA.115.06305","article-title":"Clinical Management and Outcomes of Adrenal Hemorrhage Following Adrenal Vein Sampling in Primary Aldosteronism","volume":"67","author":"Monticone","year":"2016","journal-title":"Hypertension"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCOUTCOMES.115.002002","article-title":"Cost-Effectiveness of Screening for Primary Aldosteronism and Subtype Diagnosis in the Resistant Hypertensive Patients","volume":"8","author":"Lubitz","year":"2015","journal-title":"Circ Cardiovasc Qual Outcomes"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1530\/EJE-18-0328","article-title":"Radiation exposure of adrenal vein sampling: a German Multicenter Study","volume":"179","author":"Fuss","year":"2018","journal-title":"Eur J Endocrinol"},{"key":"B11","doi-asserted-by":"publisher","first-page":"34","DOI":"10.1038\/s41371-019-0229-4","article-title":"Historical changes and between-facility differences in adrenal venous sampling for primary aldosteronism in Japan","volume":"34","author":"Fujii","year":"2020","journal-title":"J Hum Hypertens"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.1507\/endocrj.EJ11-0133","article-title":"Guidelines for the diagnosis and treatment of primary aldosteronism\u2013the Japan Endocrine Society 2009","volume":"58","author":"Nishikawa","year":"2011","journal-title":"Endocr J"},{"key":"B13","doi-asserted-by":"publisher","first-page":"253","DOI":"10.1038\/hr.2014.20","article-title":"The Japanese Society of Hypertension Guidelines for the Management of Hypertension (JSH 2014)","volume":"37","author":"Shimamoto","year":"2014","journal-title":"Hypertens Res"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.1111\/cen.12847","article-title":"Optimum position of left adrenal vein sampling for subtype diagnosis in primary aldosteronism","volume":"83","author":"Umakoshi","year":"2015","journal-title":"Clin Endocrinol (Oxf)"},{"key":"B15","doi-asserted-by":"publisher","first-page":"775","DOI":"10.1210\/endrev\/bnaa008","article-title":"Adrenal Incidentaloma","volume":"41","author":"Sherlock","year":"2020","journal-title":"Endocr Rev"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.1053\/j.ajkd.2008.12.034","article-title":"Revised equations for estimated GFR from serum creatinine in Japan","volume":"53","author":"Matsuo","year":"2009","journal-title":"Am J Kidney Dis"},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.5551\/jat.17152","article-title":"Diagnostic criteria for dyslipidemia","volume":"20","author":"Teramoto","year":"2013","journal-title":"Diagn Criteria Dyslipidemia J Atheroscler Thromb"},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.1111\/j.2040-1124.2010.00074.x","article-title":"Report of the committee on the classification and diagnostic criteria of diabetes mellitus","volume":"1","author":"Seino","year":"2010","journal-title":"J Diabetes Investig"},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2012-1917","article-title":"A clinical prediction score to diagnose unilateral primary aldosteronism","volume":"97","author":"Kupers","year":"2012","journal-title":"J Clin Endocrinol Metab"},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.1038\/jhh.2014.20","article-title":"A subtype prediction score for primary aldosteronism","volume":"28","author":"Nanba","year":"2014","journal-title":"J Hum Hypertens"},{"key":"B21","doi-asserted-by":"publisher","DOI":"10.4158\/EP15982.OR","article-title":"A new clinical prediction criterion accurately determines a subset of patients with bilateral primary aldosteronism before adrenal venous sampling","volume":"22","author":"Kocjan","year":"2016","journal-title":"Endocr Pract"},{"key":"B22","doi-asserted-by":"publisher","DOI":"10.1038\/jhh.2016.61","article-title":"Significance of adrenal computed tomography in predicting laterality and indicating adrenal vein sampling in primary aldosteronism","volume":"31","author":"Kamemura","year":"2017","journal-title":"J Hum Hypertens"},{"key":"B23","doi-asserted-by":"publisher","DOI":"10.1097\/HJH.0000000000001855","article-title":"Development and validation of subtype prediction scores for the workup of primary aldosteronism","volume":"36","author":"Kobayashi","year":"2018","journal-title":"J Hypertens"},{"key":"B24","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2017-01774","article-title":"Significance of Computed Tomography and Serum Potassium in Predicting Subtype Diagnosis of Primary Aldosteronism","volume":"103","author":"Umakoshi","year":"2018","journal-title":"J Clin Endocrinol Metab"},{"key":"B25","doi-asserted-by":"publisher","first-page":"e038489","DOI":"10.1136\/bmjopen-2020-038489","article-title":"Diagnostic accuracy of adrenal imaging for subtype diagnosis in primary aldosteronism: systematic review and meta-analysis","volume":"10","author":"Zhou","year":"2020","journal-title":"BMJ Open"},{"key":"B26","doi-asserted-by":"publisher","DOI":"10.1530\/ERC-16-0055","article-title":"Genetics of primary hyperaldosteronism","volume":"23","author":"Dutta","year":"2016","journal-title":"Endocr Relat Cancer"},{"key":"B27","doi-asserted-by":"publisher","DOI":"10.1210\/clinem\/dgaa821","article-title":"Surgical Outcomes Among Primary Aldosteronism Patients Without Visible Adrenal Lesions","volume":"106","author":"Sam","year":"2021","journal-title":"J Clin Endocrinol Metab"},{"key":"B28","doi-asserted-by":"publisher","DOI":"10.1016\/S2213-8587(17)30367-4","article-title":"Cardiometabolic outcomes and mortality in medically treated primary aldosteronism: a retrospective cohort study","volume":"6","author":"Hundemer","year":"2018","journal-title":"Lancet Diabetes Endocrinol"},{"key":"B29","doi-asserted-by":"publisher","DOI":"10.1097\/HJH.0000000000001361","article-title":"Risk of new-onset diabetes mellitus in primary aldosteronism: a population study over 5 years","volume":"35","author":"Wu","year":"2017","journal-title":"J Hypertens"},{"key":"B30","doi-asserted-by":"publisher","first-page":"16","DOI":"10.1210\/jc.2017-01442","article-title":"Quality of Life in Primary Aldosteronism: A Comparative Effectiveness Study of Adrenalectomy and Medical Treatment","volume":"103","author":"Velema","year":"2018","journal-title":"J Clin Endocrinol Metab"},{"key":"B31","doi-asserted-by":"publisher","DOI":"10.1097\/HJH.0000000000002070","article-title":"Clinical and biochemical outcomes after adrenalectomy and medical treatment in patients with unilateral primary aldosteronism","volume":"37","author":"Katabami","year":"2019","journal-title":"J Hypertens"},{"key":"B32","doi-asserted-by":"publisher","DOI":"10.1210\/js.2019-00019","article-title":"Adrenalectomy Improves the Long-Term Risk of End-Stage Renal Disease and Mortality of Primary Aldosteronism","volume":"3","author":"Chen","year":"2019","journal-title":"J Endocr Soc"},{"key":"B33","doi-asserted-by":"publisher","first-page":"e1400-7","DOI":"10.1210\/clinem\/dgaa706","article-title":"Adrenal venous sampling guided adrenalectomy rates in primary aldosteronism: results of an international cohort (AVSTAT)","volume":"106","author":"Ohno","year":"2020","journal-title":"J Clin Endocrinol Metab"}],"container-title":["Frontiers in Endocrinology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fendo.2021.645395\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,4,12]],"date-time":"2021-04-12T07:47:50Z","timestamp":1618213670000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fendo.2021.645395\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,4,12]]},"references-count":33,"alternative-id":["10.3389\/fendo.2021.645395"],"URL":"https:\/\/doi.org\/10.3389\/fendo.2021.645395","relation":{},"ISSN":["1664-2392"],"issn-type":[{"type":"electronic","value":"1664-2392"}],"subject":[],"published":{"date-parts":[[2021,4,12]]},"article-number":"645395"}}