Journal Article

Is adrenal venous sampling always necessary to differentiate between unilateral and bilateral primary aldosteronism? Lesson from the SPAIN-ALDO register

Guerrero-Vázquez, Raquel, González Boillos, Marga, Escudero Quesada, Verónica, Perdomo, Carolina M., Ruiz-Sanchez, Jorge Gabriel, Gonzalvo Diaz, Cesar, Pascual-Corrales, Eider, Vicente Delgado, Almudena, Manjón-Miguélez, Laura, García Centeno, Rogelio, Calatayud, María, Peris, Begoña Pla, Rebollo Román, Ángel, Barahona San Millan, Rebeca, Parra Ramírez, Paola, Paja Fano, Miguel, Morales-Ruiz, Manuel, Ferreira, Rui, García Sanz, Iñigo, Gómez Hoyos, Emilia, García Cano, Ana María, Furio Collao, Simone Andree, Lamas, Cristina, Percovich, Juan Carlos, Serrano Gotarredona, Joaquín, Michalopoulou Alevras, Theodora, Gracia Gimeno, Paola, Del Castillo Tous, María, Araujo-Castro, Marta, Díaz Guardiola, Patricia, Robles Lázaro, Cristina, Sampedro Nuñez, Miguel Antonio, Moya Mateo, Eva María, Recasens Sala, Mònica, Picón César, María José, Hanzu, Felicia A., Meneses, Diego, Mena Ribas, Elena, Sanmartín Sánchez, Alicia, Martín Rojas-Marcos, Patricia

2024

Overview

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.

• Publisher: Springer US,Springer Nature B.V
• Subject: Accuracy / Adrenal glands / Adrenal Glands - blood supply / Adrenal Glands - diagnostic imaging / Adrenalectomy / Adult / Aged / Aldosterone / Aldosterone - blood / Apnea / Blood pressure / Cerebrovascular diseases / Comorbidity / Diabetes / Diagnosis, Differential / Dyslipidemia / Endocrinology / Female / Hormones / Humanities and Social Sciences / Humans / Hyperaldosteronism - blood / Hyperaldosteronism - diagnosis / Hyperaldosteronism - surgery / Hypokalemia / Internal Medicine / Magnetic resonance imaging / Male / Medical imaging / Medicine / Medicine & Public Health / Middle Aged / multidisciplinary / Nodules / Original Article / Patients / Plasma / Potassium / Prediction models / Registries / Regression analysis / Retrospective Studies / Sampling / Science / Sleep disorders / Spain - epidemiology / Variables