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

Autor: Parra Ramírez P; Endocrinology & Nutrition Department, Hospital Universitario La Paz Madrid, Madrid, Spain., Martín Rojas-Marcos P; Endocrinology & Nutrition Department, Hospital Universitario La Paz Madrid, Madrid, Spain., Paja Fano M; Endocrinology & Nutrition Department. OSI Bilbao-Basurto, Hospital Universitario de Basurto, Bilbao, Spain.; Medicine Department, Basque Country University, Bilbao, Spain., González Boillos M; Endocrinology & Nutrition Department, Hospital Universitario de Castellón, Castellón, Spain., Peris BP; Endocrinology & Nutrition Department, Hospital Universitario de Castellón, Castellón, Spain., Pascual-Corrales E; Instituto de Investigación Biomédica Ramón y Cajal (IRYCIS), Madrid, Spain.; Endocrinology & Nutrition Department, Hospital Universitario Ramón y Cajal, Madrid, Spain., García Cano AM; Biochemistry Department, Hospital Universitario Ramón y Cajal, Madrid, Spain., Ruiz-Sanchez JG; Endocrinology & Nutrition Department, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain., Vicente Delgado A; Endocrinology & Nutrition Department, Hospital Universitario de Toledo, Toledo, Spain., Gómez Hoyos E; Endocrinology & Nutrition Department, Hospital Universitario de Valladolid, Valladolid, Spain., Ferreira R; Endocrinology & Nutrition Department, Hospital Universitario Rey Juan Carlos, Madrid, Spain., García Sanz I; General & Digestive Surgery Department, Hospital Universitario de La Princesa, Madrid, Spain., Recasens Sala M; Endocrinology & Nutrition Department, Hospital De Girona Doctor Josep Trueta, Girona, Spain., Barahona San Millan R; Endocrinology & Nutrition Department, Hospital De Girona Doctor Josep Trueta, Girona, Spain., Picón César MJ; Endocrinology & Nutrition Department, Hospital Universitario Virgen de la Victoria de Málaga. IBIMA Malaga. Spain CIBEROBN, Madrid, Spain., Díaz Guardiola P; Endocrinology & Nutrition Department, Hospital Universitario Infanta Sofía, Madrid, Spain., Perdomo CM; Endocrinology & Nutrition Department, Clínica Universidad de Navarra, Pamplona, Spain., Manjón-Miguélez L; Endocrinology & Nutrition Department, Hospital Universitario Central de Asturias, Oviedo, Spain.; Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Madrid, Spain., García Centeno R; Endocrinology & Nutrition Department, Hospital Universitario Gregorio Marañón, Madrid, Spain., Percovich JC; Endocrinology & Nutrition Department, Hospital Universitario Gregorio Marañón, Madrid, Spain., Rebollo Román Á; Endocrinology & Nutrition Department, Hospital Reina Sofía, Córdoba, Spain., Gracia Gimeno P; Endocrinology & Nutrition Department, Hospital Royo Villanova, Zaragoza, Spain., Robles Lázaro C; Endocrinology & Nutrition Department, Complejo Universitario de Salamanca, Salamanca, Spain., Morales-Ruiz M; Biochemistry and Molecular Genetics Department-CDB, Hospital Clinic. IDIBAPS, CIBERehd, Barcelona, Spain., Calatayud M; Endocrinology & Nutrition Department, Hospital Doce de Octubre, Madrid, Spain., Furio Collao SA; Endocrinology & Nutrition Department, Hospital Doce de Octubre, Madrid, Spain., Meneses D; Endocrinology & Nutrition Department, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain., Sampedro Nuñez MA; Endocrinology & Nutrition Department, Hospital Universitario La Princesa, Madrid, Spain., Escudero Quesada V; Nephrology Department, Hospital Universitario Doctor Peset, Valencia, Spain., Mena Ribas E; Endocrinology & Nutrition Department, Hospital Universitario Son Espases, Islas Baleares, Spain., Sanmartín Sánchez A; Endocrinology & Nutrition Department, Hospital Universitario Son Espases, Islas Baleares, Spain., Gonzalvo Diaz C; Endocrinology & Nutrition Department, Hospital Universitario De Albacete, Albacete, Spain., Lamas C; Endocrinology & Nutrition Department, Hospital Universitario De Albacete, Albacete, Spain., Guerrero-Vázquez R; Endocrinology & Nutrition Department, Hospital Universitario Virgen Macarena, Sevilla, Spain., Del Castillo Tous M; Endocrinology & Nutrition Department, Hospital Universitario Virgen Macarena, Sevilla, Spain., Serrano Gotarredona J; Endocrinology & Nutrition Department, Hospital General Universitario de Alicante, Alicante, Spain., Michalopoulou Alevras T; Endocrinology & Nutrition Department, Hospital Joan XXIII, Tarragona, Spain., Moya Mateo EM; Internal Medicine, Hospital Universitario Infanta Leonor, Madrid, Spain., Hanzu FA; Endocrinology & Nutrition Department, Hospital Clinic. IDIPAS, Barcelona, Spain., Araujo-Castro M; Instituto de Investigación Biomédica Ramón y Cajal (IRYCIS), Madrid, Spain. marta.araujo@salud.madrid.org.; Endocrinology & Nutrition Department, Hospital Universitario Ramón y Cajal, Madrid, Spain. marta.araujo@salud.madrid.org.; University of Alcalá, Madrid, Spain. marta.araujo@salud.madrid.org.
Jazyk: angličtina
Zdroj: Endocrine [Endocrine] 2024 May; Vol. 84 (2), pp. 683-693. Date of Electronic Publication: 2023 Nov 27.
DOI: 10.1007/s12020-023-03609-y
Abstrakt: 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.
(© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)
Databáze: MEDLINE
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