The Accuracy of Simple and Adjusted Aldosterone Indices for Assessing Selectivity and Lateralization of Adrenal Vein Sampling in the Diagnosis of Primary Aldosteronism Subtypes

Parasiliti-Caprino, Mirko; Bioletto, Fabio; Ceccato, Filippo; Lopez, Chiara; Bollati, Martina; Carlo, Maria Chiara Di; Voltan, Giacomo; Rossato, Denis; Giraudo, G.; Scaroni, Carla; Ghigo, Ezio; Maccario, Mauro

doi:10.3389/fendo.2022.801529

Cited by 4 publications

(3 citation statements)

References 45 publications

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“…Patients with a positive screening test are recommended to undergo confirmatory testing, either by saline infusion test, oral salt loading test, fludrocortisone suppression test, or captopril challenge test ( 1 , 8 , 10 ). Finally, patients in which a diagnosis of PA is confirmed should proceed to subtype testing by adrenal computed tomography (CT) and adrenal vein sampling (AVS), in order to identify any adrenal masses and to differentiate between unilateral and bilateral forms ( 1 , 8 , 11 – 13 ).…”

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confidence: 99%

Predictive performance of aldosterone-to-renin ratio in the diagnosis of primary aldosteronism in patients with resistant hypertension

et al. 2023

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BackgroundThe systematic use of confirmatory tests in the diagnosis of primary aldosteronism (PA) increases costs, risks and complexity to the diagnostic work-up. In light of this, some authors proposed aldosterone-to-renin (ARR) cut-offs and/or integrated flow-charts to avoid this step. Patients with resistant hypertension (RH), however, are characterized by a dysregulated renin-angiotensin-aldosterone system, even in the absence of PA. Thus, it is unclear whether these strategies might be applied with the same diagnostic reliability in the setting of RH.MethodsWe enrolled 129 consecutive patients diagnosed with RH and no other causes of secondary hypertension. All patients underwent full biochemical assessment for PA, encompassing both basal measurements and a saline infusion test.Results34/129 patients (26.4%) were diagnosed with PA. ARR alone provided a moderate-to-high accuracy in predicting the diagnosis of PA (AUC=0.908). Among normokalemic patients, the ARR value that maximized the diagnostic accuracy, as identified by the Youden index, was equal to 41.8 (ng/dL)/(ng/mL/h), and was characterized by a sensitivity and a specificity of 100% and 67%, respectively (AUC=0.882); an ARR > 179.6 (ng/dL)/(ng/mL/h) provided a 100% specificity for the diagnosis of PA, but was associated with a very low sensitivity of 20%. Among hypokalemic patients, the ARR value that maximized the diagnostic accuracy, as identified by the Youden index, was equal to 49.2 (ng/dL)/(ng/mL/h), and was characterized by a sensitivity and a specificity of 100% and 83%, respectively (AUC=0.941); an ARR > 104.0 (ng/dL)/(ng/mL/h) provided a 100% specificity for the diagnosis of PA, with a sensitivity of 64%.ConclusionsAmong normokalemic patients, there was a wide overlap in ARR values between those with PA and those with essential RH; the possibility to skip a confirmatory test should thus be considered with caution in this setting. A better discriminating ability could be seen in the presence of hypokalemia; in this case, ARR alone may be sufficient to skip confirmatory tests in a suitable percentage of patients.

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Section: Introductionmentioning

confidence: 99%

Predictive performance of aldosterone-to-renin ratio in the diagnosis of primary aldosteronism in patients with resistant hypertension

et al. 2023

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“…Primary aldosteronism (PA) is a prevalent form of secondary hypertension that carries a higher incidence of cardiovascular complications compared to hypertension alone (1), Therefore, accurate diagnosis and treatment of PA are crucial for clinicians. The major subtypes of PA include idiopathic hyperaldosteronism (IHA), aldosterone-producing adenomas (APA), primary adrenal hyperplasia, and familial aldosteronism (2).…”

Section: Introductionmentioning

confidence: 99%

“…The major subtypes of PA include idiopathic hyperaldosteronism (IHA), aldosterone-producing adenomas (APA), primary adrenal hyperplasia, and familial aldosteronism (2). The diagnosis of PA is important for giving patients the opportunity for specific surgical or pharmacological treatment to reduce cardiovascular risk (1).While Computed Tomography (CT) and adrenal venous sampling (AVS) are commonly used for diagnosing PA subtypes, conventional CT has limited diagnostic value in detecting dominant adrenal lesions (3). Clinical guidelines suggest that AVS performed by an experienced interventionalist is the gold-standard test for differentiating unilateral and bilateral PA (4).…”

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confidence: 99%

The value of CT-based energy imaging to discriminate dominant side lesions in primary aldosteronism

et al. 2023

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PurposeThe current clinical discrimination of the dominant side of primary aldosteronism (PA) mainly relies on invasive adrenal venous sampling (AVS) examination. This study investigated the feasibility of dual-energy CT energy imaging parameters as a novel biomarker in identifying bilateral adrenal dominant lesions.MethodsFifty PA patients with bilateral lesions who underwent CT and AVS of the adrenal glands at Shaanxi Provincial People’s Hospital from October 2019 to June 2021 were retrospectively analyzed. Forty-eight patients had successful bilateral blood collection and two failed right-sided blood collection due to venous variation. Forty patients who were classified based on AVS underwent unilateral adrenalectomy and pathological findings confirmed adenoma in all cases. Quantitative dual-energy CT parameters were measured for all adrenal lesions, and the differences in dual-energy CT energy spectrum imaging parameters between the dominant and nondominant adrenal lesions were compared.ResultsAmong forty-eight PA patients with bilateral lesions, forty patients with preoperative AVS-determined lesions on the dominant side underwent unilateral adrenalectomy, and eight patients without the dominant side were treated with medication. The iodine concentration difference (ICD) in the arteriovenous phase was more significant in the 40 cases of primary aldosteronism with dominant adrenal lesions than in the nondominant adrenal lesions (1.18 ± 0.45 vs 0.41 ± 0.42). The NICAP was higher in the dominant adrenal lesions than in the non-dominant lesions (0.39 ± 0.39 vs 0.14 ± 0.05). The sensitivity and specificity of the diagnosis of the dominant adrenal lesion were 88.2% and 82.4% using the ICD of 0.68 as the threshold value.ConclusionConventional CT has lower diagnostic value for dominant adrenal lesions, and CT-based energy imaging can be a new assessment method as a complement to AVS in identifying bilateral dominant adrenal lesions.

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The performance of left/right adrenal volume ratio and volume difference in predicting unilateral primary aldosteronism

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Wang

Shao

et al. 2022

J Endocrinol Invest

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The Accuracy of Simple and Adjusted Aldosterone Indices for Assessing Selectivity and Lateralization of Adrenal Vein Sampling in the Diagnosis of Primary Aldosteronism Subtypes

Cited by 4 publications

References 45 publications

Predictive performance of aldosterone-to-renin ratio in the diagnosis of primary aldosteronism in patients with resistant hypertension

Predictive performance of aldosterone-to-renin ratio in the diagnosis of primary aldosteronism in patients with resistant hypertension

The value of CT-based energy imaging to discriminate dominant side lesions in primary aldosteronism

The performance of left/right adrenal volume ratio and volume difference in predicting unilateral primary aldosteronism

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