Significance of Computed Tomography and Serum Potassium in Predicting Subtype Diagnosis of Primary Aldosteronism

Umakoshi, Hironobu; Tsuiki, Mika; Takeda, Yoshiyu; Kurihara, Isao; Itoh, Hiroshi; Katabami, Takuyuki; Ichijo, Takamasa; Wada, Norio; Yoshimoto, Takanobu; Ogawa, Yoshihiro; Kawashima, Junji; Sone, Masakatsu; Inagaki, Nobuya; Takahashi, K.; Watanabe, Minemori; Matsuda, Yuichi; Kobayashi, Hiroki; Shibata, Hirotaka; Kamemura, Kohei; Otsuki, Michio; Fujii, Yukihiko; Yamamto, Koichi; Ogo, Atsushi; Yanase, Toshihiko; Naruse, Mitsuhide

doi:10.1210/jc.2017-01774

Cited by 73 publications

(59 citation statements)

References 27 publications

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“…Computed tomography finding and serum potassium were two of the most specific predictors for differentiation in patients with PA. Several clinical scores, proposed by Zhang, Kobayashi and Kocjan, shared these two variables, CT finding and serum potassium, also confirming their discriminative value directly. In addition, in a recent study, patients with unilateral disease on CT and hypokalemia presented a high probability of a lateralization of AVS . Our nomogram, consisting of these two classic predictive factors, was in line with previous studies.…”

Section: Discussionsupporting

confidence: 89%

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A novel clinical nomogram to predict bilateral hyperaldosteronism in Chinese patients with primary aldosteronism

Wang¹,

Jiang²,

Zhang³

et al. 2019

Clinical Endocrinology

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Summary Context Adrenal venous sampling (AVS) is recommended as the gold standard for subtype classification in primary aldosteronism (PA); however, this approach has limited availability. Objective We aimed to develop a novel clinical nomogram to predict PA subtype based on routine variables, thereby reducing the number of candidates for AVS. Patients and method Patients were randomly divided into a training set (n = 185) and a validation set (n = 79). Risk factors for idiopathic hyperaldosteronism (IHA) differentiating from aldosterone‐producing adenoma (APA) were identified using logistic regression analysis. A nomogram was constructed to predict the probability of IHA. A receiver operating characteristic (ROC) curve and a calibration plot were applied to assess the predictive value. Then, 115 patients were prospectively enrolled, and a nomogram was used to predict the subtypes before AVS. Results Body mass index (BMI), serum potassium and computed tomography (CT) finding were adopted in the nomogram. The nomogram presented an area under the ROC (AUC) of 0.924 (95% CI: 0.875‐0.957), sensitivity of 86.59% and specificity of 87.38% in the training set and an AUC of 0.894 (95% CI: 0.804‐0.952), sensitivity of 82.86% and specificity of 84.09% in the validation set. Predicted probability and actual probability matched well in the nomogram (Hosmer‐Lemeshow test: P > 0.05). Using the nomogram as a surrogate to predict IHA in the prospective set before AVS, the specificity reached 100% when we increased the threshold to a probability of 90%. Conclusion We have developed a tool that is able to predict IHA in patients with PA and potentially avoid AVS.

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Section: Discussionsupporting

confidence: 89%

“…In addition, in a recent study, patients with unilateral disease on CT and hypokalemia presented a high probability of a lateralization of AVS. 28 Our nomogram, consisting of these two classic predictive factors, was in line with previous studies.…”

Section: Discussionsupporting

confidence: 88%

A novel clinical nomogram to predict bilateral hyperaldosteronism in Chinese patients with primary aldosteronism

Wang¹,

Jiang²,

Zhang³

et al. 2019

Clinical Endocrinology

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“…The JPAS was a multicentre collaborative study conducted in 28 centres in Japan. The details of the JPAS are described elsewhere . This retrospective study was analysed using the JPAS data set valid in October 2016.…”

Section: Methodsmentioning

confidence: 99%

“…The reference range of PAC in the supine position was 3.0‐15.9 ng/dL (80‐440 pmol/L). Details of the PRA assay are described elsewhere …”

Section: Methodsmentioning

confidence: 99%

“…Although imaging a nodule does not prove hormonal autonomy, computed tomography (CT) is the most commonly available imaging method for distinguishing between patients with unilateral and bilateral subtypes of PA . Recently, we have reported that a combination of CT findings and serum potassium status can aid in assessing the need for AVS, but this approach was not sufficient to determine whether AVS can be omitted before proceeding to surgery. An Endocrine Society Clinical Practice Guideline published in 2016 remarked that younger patients (aged <35 years) with spontaneous hypokalaemia, marked aldosterone excess and unilateral adrenal lesions with radiological features consistent with a cortical adenoma on adrenal CT scan may not need AVS before proceeding to unilateral adrenalectomy.…”

Section: Introductionmentioning

confidence: 99%

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Accuracy of adrenal computed tomography in predicting the unilateral subtype in young patients with hypokalaemia and elevation of aldosterone in primary aldosteronism

Umakoshi

Ogasawara

Takeda

et al. 2018

Clinical Endocrinology

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Accuracy of Gallium-68 Pentixafor Positron Emission Tomography–Computed Tomography for Subtyping Diagnosis of Primary Aldosteronism

Shen

et al. 2023

JAMA Netw Open

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ImportanceAdrenal vein sampling (AVS) is the recommended procedure for subtyping primary aldosteronism (PA) as unilateral PA (UPA) or bilateral PA (BPA), with different treatment needed for each: adrenalectomy for UPA and medication for BPA. However, AVS is invasive and technically difficult, and how to subtype PA noninvasively is currently a great challenge.ObjectiveTo evaluate the accuracy of gallium-68 pentixafor positron emission tomography–computed tomography (PET-CT) in subtyping PA using AVS as a reference standard.Design, Setting, and ParticipantsThis diagnostic study was conducted at a tertiary hospital in China among patients diagnosed with PA. Enrollment was started in November 2021, with follow-up ending in May 2022.Exposures: Patients were recruited to undergo gallium-68 pentixafor PET-CT and AVS.Main Outcomes and MeasuresMaximum standardized uptake value (SUVmax) of each adrenal gland during PET-CT was measured to calculate the lateralization index of SUVmax. Area under the receiver operating characteristic curve (AUROC), specificity, and sensitivity were used to analyze the accuracy of the lateralization index based on SUVmax for subtyping PA.ResultsAmong 100 patients with PA who completed the study (47 female [47.0%] and 53 male [53.0%]; median [IQR] age, 49 [38-56] years), 43 individuals had UPA and 57 individuals had BPA. Aldosterone-cortisol ratio (Spearman ρ = 0.26; P &lt; .001) in adrenal veins was positively correlated with SUVmax of adrenal glands at 10 minutes during PET-CT. Using lateralization index based on SUVmax at 10 minutes to identify UPA, the AUROC was 0.90 (95% CI, 0.83-0.97). A cutoff value for lateralization index based on SUVmax at 10 minutes set at 1.65 conferred a specificity of 1.00 (95% CI, 0.94-1.00) and sensitivity of 0.77 (95% CI, 0.61-0.88). The diagnostic concordance rate of PET-CT and AVS was 90 patients (90.0%) compared with 54 patients (54.0%) between traditional CT and AVS.Conclusions and RelevanceThis study found good diagnostic accuracy of gallium-68 pentixafor PET-CT in differentiating UPA from BPA. These findings suggest that gallium-68 pentixafor PET-CT may be used to avoid invasive AVS in some patients with PA.

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Significance of Computed Tomography and Serum Potassium in Predicting Subtype Diagnosis of Primary Aldosteronism

Abstract: Patients with PA with bilateral normal results on CT and normokalemia likely have a low prior probability of a lateralized form of AVS and could be treated medically, whereas those with unilateral disease on CT and hypokalemia have a high probability of a lateralized form of AVS.

Cited by 73 publications

References 27 publications

A novel clinical nomogram to predict bilateral hyperaldosteronism in Chinese patients with primary aldosteronism

A novel clinical nomogram to predict bilateral hyperaldosteronism in Chinese patients with primary aldosteronism

Accuracy of adrenal computed tomography in predicting the unilateral subtype in young patients with hypokalaemia and elevation of aldosterone in primary aldosteronism

Accuracy of Gallium-68 Pentixafor Positron Emission Tomography–Computed Tomography for Subtyping Diagnosis of Primary Aldosteronism

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