Abstract
Purpose: The purpose was to investigate the most accurate method of adrenal venous sampling to diagnose unilateral primary aldosteronism (PA) prior to laterality assessment. Materials and Methods: Sixty-four consecutive PA patients were enrolled in this retrospective study. A catheter was placed in the common-trunk-vein (CTV), below the confluence of the inferior-phrenic-vein and the central-adrenal-vein (CAV) and the right-adrenal-vein (RAV). Blood-sampling was performed both pre- and post-adrenocorticotropic hormone stimulation. Lateralized ratio [LR; aldosterone/cortisol ratio (ACR) on high-value side/ACR on low-value side], contralateral ratio (CR; ACR on low-value side/ACR on inferior-vena-cava ratio), and plasma aldosterone concentration (PAC) were evaluated. The diagnostic accuracy of LR, CR and PAC in CTV/ CAV/RAV during pre- and post-ACTH was compared by receiver-operating-characteristic (ROC) analysis. Results: LR-CAV post-ACTH showed the highest detection rate for unilateral adrenal lesions (93.3%; 14/15), with a sensitivity of 0.93 and a specificity of 0.84 at a cut-off value of 2.5. CR-post-ACTH had the highest Az value (0.89), with a detection rate of 86.7% (13/14), a sensitivity of 0.98, and a specificity of 0.88 at a cut-off value of 0.8. Conclusion: CR-post-ACTH and LR-CAV-post-ACTH are accurate predictors for laterality assessment in PA.
Highlights
Primary aldosteronism (PA) is defined as “the group of disorders in which aldosterone production is inappropriately high, relatively autonomous from the renin-angiotensin system, and non-suppressible by sodium loading” by the American Endocrine Society Guidelines [1]
lateralized ratio (LR)-CAV post-adrenocorticotropic hormone (ACTH) showed the highest detection rate for unilateral adrenal lesions (93.3%; 14/15), with a sensitivity of 0.93 and a specificity of 0.84 at a cut-off value of 2.5
contralateral ratio (CR) post-ACTH had the highest Az value, with a detection rate of 86.7%, a sensitivity of 0.980, and a specificity of 0.889, when the cut-off value was set at 0.8. These results were superior to those of LR-CAV post-ACTH, the detection rate of LR-CAV post-ACTH was superior to that of CR post-ACTH. These findings suggest that both LR-CAV post-ACTH and CR post-ACTH can be used to determine the laterality of primary aldosteronism (PA)
Summary
Primary aldosteronism (PA) is defined as “the group of disorders in which aldosterone production is inappropriately high, relatively autonomous from the renin-angiotensin system, and non-suppressible by sodium loading” by the American Endocrine Society Guidelines [1]. It is important to diagnosis PA from essential hypertension since PA patients have a higher cardiovascular complication rate than patients with essential hypertension [3]. Both of aldosteroneproducing adenomas (APA) and bilateral idiopathic hyperaldosteronism (IHA) are the most common subtypes of PA. The management of PA depends on whether adrenal gland is involved unilaterally or bilaterally. PA patients with unilateral involvement are managed surgically (e.g. laparoscopic adrenalectomy), whereas those with bilateral involvement are medically managed (e.g. with mineralocorticoid receptor antagonists). Hypertension usually improves dramatically after surgery in most of the patients with unilateral APA [4]. Accurate laterality assessments contribute to the appropriate treatment, which improve the prognosis of PA patients
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
