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- Title
Is adrenal venous sampling always necessary to differentiate between unilateral and bilateral primary aldosteronism? Lesson from the SPAIN-ALDO register.
- Authors
Parra Ramírez, Paola; Martín Rojas-Marcos, Patricia; Paja Fano, Miguel; González Boillos, Marga; Peris, Begoña Pla; Pascual-Corrales, Eider; García Cano, Ana María; Ruiz-Sanchez, Jorge Gabriel; Vicente Delgado, Almudena; Gómez Hoyos, Emilia; Ferreira, Rui; García Sanz, Iñigo; Recasens Sala, Mònica; Barahona San Millan, Rebeca; Picón César, María José; Díaz Guardiola, Patricia; Perdomo, Carolina M.; Manjón-Miguélez, Laura; García Centeno, Rogelio; Percovich, Juan Carlos
- Abstract
Purpose: To evaluate whether the clinical, biochemical and radiological features of patients with primary aldosteronism (PA) can predict both main subtypes of PA. Methods: A retrospective multicenter study of PA patients followed in 27 Spanish tertiary hospitals (SPAIN-ALDO Register). Only patients with confirmed unilateral or bilateral PA based on adrenal venous sampling (AVS) and/or postsurgical biochemical cure after adrenalectomy were included. Supervised regression techniques were used for model development. Results: 328 patients [270 unilateral PA (UPA), 58 bilateral PA (BPA)] were included. The area under the curve (AUC) for aldosterone/potassium ratio and aldosterone responses following saline infusion test were 0.602 [95%CI 0.520 to 0.684] and 0.574 [95% CI 0.446–0.701], respectively, to differentiate UPA from BPA. The AUC was 0.825 [95% 0.764–0.886] when the prediction model with seven parameters – comorbidities (dyslipidemia, cerebrovascular disease, sleep apnea syndrome [SAS]), systolic blood pressure (SBP), plasma aldosterone levels (PAC), hypokalemia and unilateral adrenal nodule >1 cm and normal contralateral adrenal gland on CT/MRI – was used. In patients without comorbidities, hypokalemia, SBP > 160 mmHg, PAC > 40 ng/dL, and unilateral adrenal lesions were associated with a likelihood of having a UPA of 98.5%. The chance of BPA was higher in individuals with comorbidities, SBP < 140 mmHg, normokalemia, low PAC levels, and no adrenal tumors on the CT/MRI (91.5%). Conclusion: A combination of high PAC, SBP > 160 mmHg, low serum potassium, a unilateral adrenal nodule>1 cm and no comorbidities could predict a UPA with a 98.5% accuracy.
- Publication
Endocrine (1355008X), 2024, Vol 84, Issue 2, p683
- ISSN
1355-008X
- Publication type
Article
- DOI
10.1007/s12020-023-03609-y