Development and validation of subtype prediction scores for the workup of primary aldosteronism

Kobayashi, Hiroki; Abe, Masanori; Soma, Masayoshi; Takeda, Yoshiyu; Kurihara, Isao; Itoh, Hiroshi; Umakoshi, Hironobu; Tsuiki, Mika; Katabami, Takuyuki; Ichijo, Takamasa; Wada, Norio; Yoshimoto, Takanobu; Ogawa, Yoshihiro; Kawashima, Junji; Sone, Masakatsu; Inagaki, Nobuya; Takahashi, K.; Watanabe, Minemori; Matsuda, Yuichi; Shibata, Hirotaka; Kamemura, Kohei; Yanase, Toshihiko; Otsuki, Michio; Fujii, Yukihiko; Yamamoto, Kōichi; Ogo, Atsushi; Nanba, Kazutaka; Tanabe, Akiyo; Suzuki, Tomoko; Naruse, Mitsuhide

doi:10.1097/hjh.0000000000001855

Cited by 53 publications

(53 citation statements)

References 27 publications

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“…For the development of glucose intolerance, insulin secretion impairment seems to play a more important role in APA compared with IHA. Previous studies have reported that APA has lower potassium levels and higher PAC compared with IHA, and these parameters might be beneficial in predicting the subtype of PA [28][29][30] . Similar to these previous studies, APA showed lower potassium levels and higher PAC in the present study.…”

Section: Discussionmentioning

confidence: 94%

Different pathogenesis of glucose intolerance in two subtypes of primary aldosteronism: Aldosterone‐producing adenoma and idiopathic hyperaldosteronism

Okazaki-Hada

Moriya

Nagao

et al. 2020

J of Diabetes Invest

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Aims/Introduction An increased risk of diabetes mellitus has been reported in primary aldosteronism, but the pathogenesis of glucose intolerance between the primary aldosteronism subtypes remains unclear. This study aimed to evaluate glucose metabolism in oral glucose tolerance test between aldosterone‐producing adenoma and idiopathic hyperaldosteronism, and characterize patients with improved glucose intolerance after primary aldosteronism treatment. Materials and Methods Oral glucose tolerance test was carried out in 116 patients who were diagnosed with primary aldosteronism and received adrenal venous sampling for subtyping. Oral glucose tolerance test was re‐evaluated after starting the treatment of primary aldosteronism for those who had glucose intolerance before the treatment. Results A total of 46.4% and 52.3% of patients with aldosterone‐producing adenoma and idiopathic hyperaldosteronism, respectively, were diagnosed with impaired glucose tolerance or diabetes. The insulinogenic index was significantly lower in aldosterone‐producing adenoma than in idiopathic hyperaldosteronism ( P = 0.045), whereas the Matsuda insulin sensitivity index was significantly higher in aldosterone‐producing adenoma than in idiopathic hyperaldosteronism ( P = 0.022). After the treatment of primary aldosteronism, glucose intolerance was improved in 66.6% and 45.8% of aldosterone‐producing adenoma and idiopathic hyperaldosteronism, respectively. The presence of obesity and central obesity were significantly lower in patients who improved glucose intolerance after the treatment of primary aldosteronism as compared with those not improved ( P = 0.013 and P = 0.033, respectively). Conclusions Insulin secretion impairment and insulin resistance play pathogenic roles for glucose intolerance in aldosterone‐producing adenoma and idiopathic hyperaldosteronism, respectively. In addition, primary aldosteronism treatments can ameliorate glucose intolerance more effectively in patients without obesity and/or central obesity.

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Section: Discussionmentioning

confidence: 94%

Different pathogenesis of glucose intolerance in two subtypes of primary aldosteronism: Aldosterone‐producing adenoma and idiopathic hyperaldosteronism

Okazaki-Hada

Moriya

Nagao

et al. 2020

J of Diabetes Invest

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“…Some studies have predicted subtype diagnosis without AVS [17][18][19][20]. Unlike these studies, the purpose of our study was to examine the usefulness of CCT alone for predicting subtype diagnosis of PA.…”

Section: Endocrine Journal Advance Publicationmentioning

confidence: 99%

“…Unlike these studies, the purpose of our study was to examine the usefulness of CCT alone for predicting subtype diagnosis of PA. Compared to the studies using a prediction score [17][18][19], the method we used in this study was simple. Umakoshi et al reported a simple method for predicting subtype diagnosis on AVS using a combination of CT findings and serum potassium levels [20].…”

Section: Endocrine Journal Advance Publicationmentioning

confidence: 99%

Prediction of unilateral hyperaldosteronism on adrenal vein sampling using captopril challenge test in patients with primary aldosteronism

et al. 2021

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Captopril challenge test (CCT) is a simple and safe confirmatory test for primary aldosteronism (PA). We investigated the effectiveness of the indices after captopril administration for prediction of unilateral hyperaldosteronism (UHA) on adrenal vein sampling (AVS). We studied 238 patients with PA who had CCT and successful AVS between July 2007 and December 2019 in Sapporo City General Hospital. Receiver operating characteristic (ROC) curve analysis showed that the diagnostic performance for prediction of UHA on AVS in regard to the reduction rate of plasma aldosterone concentration (PAC) after captopril administration was inferior to aldosterone to renin ratio (ARR) and PAC (area under the ROC curve 0.72 vs. 0.84, 0.72 vs. 0.89, respectively, both p < 0.01). Based on the optimal cut-off values in ARR (897 pg/mL/ng/mL/h, sensitivity 64.6%, specificity 93.0%) and PAC (203 pg/mL, sensitivity 73.9%, specificity 93.0%) after captopril administration, the patients were divided into three groups: (1) both positive, (2) one positive, and (3) both negative. The prevalence of UHA on AVS in the three groups were 90.0%, 52.9%, and 7.3%, respectively. In the first group, 31 of 32 patients with unilateral nodular lesion on CT had an ipsilateral unilateral AVS. In conclusion, the combination of postcaptopril ARR and PAC is useful for prediction of laterality diagnosis on AVS. AVS is strongly recommended in patients with both positive or one positive results for the optimal cut-off values of post-captopril ARR and PAC and is weakly recommended in patients with both negative results.

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“…It has been shown that most patients with an ARR > 400 have unilateral APA . Recent studies introduced the prediction score of classifying the PA subtype mainly based on the severity of the disease . Using these prediction scores, the possibility of IHA was consistently low in this case.…”

Section: Discussionmentioning

confidence: 84%

A case of primary aldosteronism with resistant hypertension successfully treated by unilateral adrenalectomy after unsuccessful classification of subtype in adrenal venous sampling

Nakamaru

Yamamoto

Nozato

et al. 2019

Clinical Case Reports

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Development and validation of subtype prediction scores for the workup of primary aldosteronism

Cited by 53 publications

References 27 publications

Different pathogenesis of glucose intolerance in two subtypes of primary aldosteronism: Aldosterone‐producing adenoma and idiopathic hyperaldosteronism

Different pathogenesis of glucose intolerance in two subtypes of primary aldosteronism: Aldosterone‐producing adenoma and idiopathic hyperaldosteronism

Prediction of unilateral hyperaldosteronism on adrenal vein sampling using captopril challenge test in patients with primary aldosteronism

A case of primary aldosteronism with resistant hypertension successfully treated by unilateral adrenalectomy after unsuccessful classification of subtype in adrenal venous sampling

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