Clinical prediction model for primary aldosteronism subtyping and special focus on adrenal volumetric assessment.

Autor: Barlas T; Faculty of Medicine, Department of Endocrinology and Metabolism, Gazi University, Ankara, Turkey. drtugbabarlas@gmail.com., Ilgit ET; Faculty of Medicine, Department of Radiology, Gazi University, Ankara, Turkey., Akkan MK; Faculty of Medicine, Department of Radiology, Gazi University, Ankara, Turkey., Cindil E; Faculty of Medicine, Department of Radiology, Gazi University, Ankara, Turkey., Gultekin II; Faculty of Medicine, Department of Radiology, Gazi University, Ankara, Turkey., Sodan HN; Faculty of Medicine, Department of Endocrinology and Metabolism, Gazi University, Ankara, Turkey., Yalcin MM; Faculty of Medicine, Department of Endocrinology and Metabolism, Gazi University, Ankara, Turkey., Cerit ET; Faculty of Medicine, Department of Endocrinology and Metabolism, Gazi University, Ankara, Turkey., Sozen S; Faculty of Medicine, Department of Urology, Gazi University, Ankara, Turkey., Akturk M; Faculty of Medicine, Department of Endocrinology and Metabolism, Gazi University, Ankara, Turkey., Toruner F; Faculty of Medicine, Department of Endocrinology and Metabolism, Gazi University, Ankara, Turkey., Karakoc A; Faculty of Medicine, Department of Endocrinology and Metabolism, Gazi University, Ankara, Turkey., Altinova AE; Faculty of Medicine, Department of Endocrinology and Metabolism, Gazi University, Ankara, Turkey.
Jazyk: angličtina
Zdroj: Hormones (Athens, Greece) [Hormones (Athens)] 2024 Sep; Vol. 23 (3), pp. 575-584. Date of Electronic Publication: 2024 Mar 27.
DOI: 10.1007/s42000-024-00548-9
Abstrakt: Purpose: Our aim was to develop a prediction model based on a simple score with clinical, laboratory, and imaging findings for the subtype diagnosis of primary aldosteronism (PA). The contribution of adrenal volumetric assessment to PA subtyping was also investigated.
Methods: Thirty-five patients with adequate cannulation in adrenal venous sampling (AVS) were included. Laboratory data, the saline infusion test (SIT), and the AVS results of patients with PA were retrospectively evaluated. Volumetric assessment was performed using magnetic resonance imaging (MRI) and the ratio of adrenal volumes was calculated after adjusting for gender- and side-specific mean reference values of both adrenal glands.
Results: The AVS was consistent with unilateral PA in 49% and bilateral in 51% of the patients. Hypertension as a reason for work-up, the highest aldosterone/lowest potassium value higher than 12, the percentage of plasma aldosterone concentration (PAC) reduction after SIT by equal or less than 43.5%, the use of oral potassium replacement, unilateral disease at pre-AVS imaging, and a ratio of adjusted adrenal volumes equal to or below 1.7 were indicative of unilateral disease in univariate logistic regression analysis concerning the distinction of PA subtyping (p < 0.05). Multivariate logistic regression analysis also revealed that adrenal volumetric assessment has an impact on PA subtyping (p < 0.05). In the prediction model, when each of the six parameters that were significant in the univariate logistic regression analysis was assigned one point, < 4 predicted bilateral PA, whereas ≥ 4 predicted unilateral PA (AUC:0.92, p < 0.001).
Conclusion: This prediction model before AVS may serve as a convenient and practical approach, while an adjusted adrenal volumetric assessment can make a positive contribution to PA subtyping.
(© 2024. The Author(s), under exclusive licence to Hellenic Endocrine Society.)
Databáze: MEDLINE
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