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

Autor: Parra Ramírez, Paola, Martín Rojas-Marcos, Patricia, Paja Fano, Miguel, González Boillos, Marga, Peris, Begoña Pla, Pascual-Corrales, Eider, García Cano, Ana María, Ruiz-Sanchez, Jorge Gabriel, Vicente Delgado, Almudena, Gómez Hoyos, Emilia, Ferreira, Rui, García Sanz, Iñigo, Recasens Sala, Mònica, Barahona San Millan, Rebeca, Picón César, María José, Díaz Guardiola, Patricia, Perdomo, Carolina M., Manjón-Miguélez, Laura, García Centeno, Rogelio, Percovich, Juan Carlos, Rebollo Román, Ángel, Gracia Gimeno, Paola, Robles Lázaro, Cristina, Morales-Ruiz, Manuel, Calatayud, María, Furio Collao, Simone Andree, Meneses, Diego, Sampedro Nuñez, Miguel Antonio, Escudero Quesada, Verónica, Mena Ribas, Elena, Sanmartín Sánchez, Alicia, Gonzalvo Diaz, Cesar, Lamas, Cristina, Guerrero-Vázquez, Raquel, Del Castillo Tous, María, Serrano Gotarredona, Joaquín, Michalopoulou Alevras, Theodora, Moya Mateo, Eva María, Hanzu, Felicia A., Araujo-Castro, Marta
Zdroj: Endocrine; 20240101, Issue: Preprints p1-11, 11p
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.
Databáze: Supplemental Index
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