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Horm Metab Res 2017; 49(12): 936-942
DOI: 10.1055/s-0043-120524
Review
© Georg Thieme Verlag KG Stuttgart · New York

The SPARTACUS Trial: Controversies and Unresolved Issues

Felix Beuschlein
1   Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, LMU, Munich, Germany
2   Klinik für Endokrinologie, Diabetologie und Klinische Ernährung, Universitätsspital Zürich, Zürich, Switzerland
,
Paolo Mulatero
3   Division of Internal Medicine and Hypertension, Department of Medical Sciences, University of Torino, Torino, Italy
,
Evelyn Asbach
1   Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, LMU, Munich, Germany
,
Silvia Monticone
3   Division of Internal Medicine and Hypertension, Department of Medical Sciences, University of Torino, Torino, Italy
,
Cristiana Catena
4   Clinica Medica and Chair of Internal Medicine, Department of Medicine, University of Udine, Udine, Italy
,
Leonardo A. Sechi
4   Clinica Medica and Chair of Internal Medicine, Department of Medicine, University of Udine, Udine, Italy
,
Michael Stowasser
5   Endocrine Hypertension Research Centre, University of Queensland Diamantina Institute, Greenslopes and Princess Alexandra Hospitals, Brisbane, Australia
› Author Affiliations
Further Information

Publication History

received 31 July 2017

accepted 20 September 2017

Publication Date:
17 November 2017 (online)

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Abstract

Adrenal vein sampling (AVS) is considered the gold standard for the differential diagnosis in patients with primary aldosteronism (PA). The distinction between unilateral and bilateral disease dictates the targeted therapeutic approach with surgery for aldosterone producing adenomas and medical therapy for patients with bilateral hyperplasia. Thereby, this diagnostic step is crucial in clinical care. As AVS is an invasive, not well standardized procedure that is restricted to few specialized centers, several attempts have been made to simplify diagnostic algorithms. In this clinical scenario, the recently published SPARTACUS trial aimed at answering the question whether AVS in fact is superior for differential diagnosis in comparison to imaging of the adrenal glands. In this multicenter study, patients were randomized to be treated according to AVS results or based on abdominal imaging only. Clinical outcome in both patient groups after one year was reported as not different. While the study results found broad interest, it also stirred considerable controversies. This review provides an overview on the different views regarding the outline of the SPARTACUS trial and the interpretation of its results.

Key words

primary aldosteronism - differential diagnosis - randomized controlled trial
 

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