Subtype prediction in primary aldosteronism: measurement of circadian variation of adrenocortical hormones and 24‐h urinary aldosterone

Abstract

PAC at different blood sampling times and 24-h urinary aldosterone level may be diagnostically helpful in discriminating between UHA and BHA. We believe that these tests could reduce the number of unnecessary AVS procedures.

Scoring system for the diagnosis of bilateral primary aldosteronism in the outpatient setting before adrenal venous sampling

“…Among the variables that were significantly different between the UHA and BHA groups on univariate analysis, we chose three safe, convenient and objective variables, which could be assessed in the outpatient setting: serum potassium concentration, ARR after CCT and prevalence of adrenal nodules on CT imaging . We did not include baseline PAC in the multivariate analysis because PAC varied according to the time of blood collection, duration of rest before collecting blood and patient's posture when blood samples were taken . We also did not choose PAC after SIT because of the many possible side effects, including acute heart failure, hypertension, hypokalaemia and orthostatic hypotension; furthermore, these tests cannot be performed in the outpatient settings .…”

“…Thus, we chose CCT as a variable in our new scoring system. In addition, we did not use baseline PAC even if it had a strong diagnostic ability for PA subtyping because its diagnostic ability for PA subtyping depended on the timing of blood sampling and duration of the rest period before blood sampling . Several other factors are also known to affect aldosterone levels.…”

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

“…As reported, patients with lower BMI (the cut‐off value was approximately 25 kg/m 2 ) were most likely to have complete resolution of hypertension after adrenalectomy . Furthermore, a large number of studies presented a trend that patients with IHA had higher BMI than patients with APA . More importantly, BMI > 25 kg/m 2 , presenting an odds ratio of 1.665, acted as an independent risk factor for differentiating IHA from APA in a recent study .…”

“…However, each model has its own specific predictors, such as estimated glomerular filtration rate (eGFR), urinary aldosterone level, plasma aldosterone concentration (PAC) to plasma rennin activity (PRA) ratio (ARR) after captopril challenge test (CCT) and post‐SIT PAC. In addition, clinical variables and tests have been identified in differentiation between APA and IHA, such as age, parathyroid hormone, ACTH stimulation test, posture stimulation test and urinary 18‐hydroxycortisol …”

“…In addition, clinical variables and tests have been identified in differentiation between APA and IHA, such as age, parathyroid hormone, ACTH stimulation test, posture stimulation test and urinary 18-hydroxycortisol. [6][7][8][9][11][12][13][14][15][16][17] Computed tomography findings are inadequate for subtype diagnosis because of the presence of microadenoma, nonfunctioning adenoma or the coexistence of both. [18][19][20][21][22] That is, even if CT findings or clinical scales could specifically distinguish IHA from APA, we could not decide which adrenal gland is presenting excessive secretion.…”