A novel clinical nomogram to predict bilateral hyperaldosteronism in Chinese patients with primary aldosteronism

Abstract

Summary Context Adrenal venous sampling (AVS) is recommended as the gold standard for subtype classification in primary aldosteronism (PA); however, this approach has limited availability. Objective We aimed to develop a novel clinical nomogram to predict PA subtype based on routine variables, thereby reducing the number of candidates for AVS. Patients and method Patients were randomly divided into a training set (n = 185) and a validation set (n = 79). Risk factors for idiopathic hyperaldosteronism (IHA) differentiating from aldosterone‐producing adenoma (APA) were identified using logistic regression analysis. A nomogram was constructed to predict the probability of IHA. A receiver operating characteristic (ROC) curve and a calibration plot were applied to assess the predictive value. Then, 115 patients were prospectively enrolled, and a nomogram was used to predict the subtypes before AVS. Results Body mass index (BMI), serum potassium and computed tomography (CT) finding were adopted in the nomogram. The nomogram presented an area under the ROC (AUC) of 0.924 (95% CI: 0.875‐0.957), sensitivity of 86.59% and specificity of 87.38% in the training set and an AUC of 0.894 (95% CI: 0.804‐0.952), sensitivity of 82.86% and specificity of 84.09% in the validation set. Predicted probability and actual probability matched well in the nomogram (Hosmer‐Lemeshow test: P > 0.05). Using the nomogram as a surrogate to predict IHA in the prospective set before AVS, the specificity reached 100% when we increased the threshold to a probability of 90%. Conclusion We have developed a tool that is able to predict IHA in patients with PA and potentially avoid AVS.

Computed tomography combined with confirmatory tests for the diagnosis of aldosterone-producing adenoma

“…Considering the accuracy of adrenal CT or the CCT, the SIT alone as a diagnostic method for APA is not satisfactory, and researchers have built some other diagnostic models as substitutes for AVS. Studies found that when CT was combined with other parameters such as serum potassium or BMI, the diagnostic value for APA could be improved [13,26]. Troy HP et al used the baseline aldosterone-to-lowest potassium ratio (APR, ng/dL/mmol/L) to predict unilateral PA, and the results showed that the probability of unilateral PA was 91.4% with an APR greater than 15 [31].…”

“…We set the APA diagnostic criteria based on previous studies [11][12][13]. An aldosterone-producing adenoma (APA) was diagnosed based on the following criteria: (1) a surgically and pathologically confirmed unilateral adrenal adenoma with a normal ARR postoperatively; (2) an outcome of adrenalectomy at the follow-up characterized by normokalemia and cured or improved hypertension 3 months after adrenalectomy [3]; (3) lateralization of aldosterone secretion on AVS.…”

Predicting factors related with uncured hypertension after retroperitoneal laparoscopic adrenalectomy for unilateral primary aldosteronism

“…The authors concluded that AVS is an imperfect test to identify the aldosterone-producing adrenal abnormalities. Bilateral aldosterone-producing adenoma and hyperplasia can occur simultaneously, [40] a standard and repeated AVS need to be given to these patients.…”

Adrenal Venous Sampling for Subtype Diagnosis of Primary Hyperaldosteronism

“…In contrast, patients with a low PAC and aldosterone to renin ratio (ARR), obesity, female sex, normokalemia, and no adrenal tumors on CT [ 46 – 50 ] showed a higher risk of bilateral disease. Approximately 95% of patients with PA with normokalemia and normal adrenal CT findings had bilateral disease [ 46 ].…”