Diagnostic Accuracy of Adrenal Venous Sampling in Comparison with Other Parameters in Primary Aldosteronism

Abstract

Abstract. This retrospective study was aimed 1) to compare the difference of the findings between adrenal CT scan and adrenal venous sampling (AVS) in 35 cases with definite primary aldosteronism (PA) for assessment of the diagnostic efficacy of PA subgroup (unilateral and bilateral adrenal hypersecretion: UAH and BAH), and 2) to determine the clinical and biochemical parameters as potential predictors for PA subgroup. There were significant discordant results based on AVS and CT scan in subgrouping PA; 9 of 17 BAH patients (53%) had unilateral lesion on CT scan, while 4 of 18 UAH patients (22%) had no apparent or bilateral lesions on CT scan. Among three diagnostic criteria, absolute values of plasma aldosterone concentration (PAC) in both adrenal veins, lateralized and contralateral ratios of aldosterone/cortisol after ACTH stimulation during AVS to determine the laterality, none of them showed 100% diagnostic accuracy if applied alone. Among several clinical and biochemical parameters, hypokalemia (<3.4 mEq/l), younger age (<52 y) and poor response of PAC (<1.45) after furosemide-upright posture, proved to be significant predictors for UAH, with higher specificities (100%, 88%, 94%, respectively). Therefore, despite AVS as a gold standard method to determine the laterality of aldosterone hypersecretion in PA, our study shows that no single criterion could provide definite diagnostic value for its laterality by AVS. It is also suggested that most PA patients, if not all, with a distinct unilateral adrenal lesion on CT accompanied by hypokalemia, younger age and poor aldosterone response to renin stimulation, could undergo adrenalectomy without prior AVS.

ACTH stimulation test and computed tomography are useful for differentiating the subtype of primary aldosteronism

“…The other report used the criteria of serum potassium ≤ 3.4 mEq/L, PAC ≥ 165 pg/mL, and ARR ≥ 1,000 on the CCT [18]. Minami et al reported that some PA patients, if not all, with a distinct unilateral adrenal lesion on CT and profound hypokalemia, younger age, and poor response of the PAC after FUT, may not require AVS in the PA subgroup [19]. In the present study, potassium concentration showed a trend to be lower in the unilateral group than in the bilateral group, but potassium concentration was not identified as a predictive factor on multivariate analysis.…”

The diagnosis and surgical management of juxtaglomerular cell tumor of the kidney

“…Laboratory features of the typical characteristics of JCT of the kidney are high renin and aldosterone, which are different from primary aldosteronism and can be revealed by posture test [10,11]. Repeated posture tests are extremely essential to diagnose the typical tumor, but they are negative in atypical and nonfunctioning patients.…”

Clinicopathological features of primary aldosteronism associated with subclinical Cushing's syndrome

“…The diagnosis of PA was made on the basis of suppressed plasma renin activity (PRA) (≤1.0 ng/mL/hr) and elevated plasma aldosterone concentration (PAC) (≥15 ng/dL) and/or PAC to PRA ratio (ARR) (>20), and subsequent confirmation by suppressed PRA (≤1.0 ng/mL/hr) after furosemideupright posture [12]. A rapid ACTH test (Cortrosyn ® 250 μg, iv bolus) was also performed [13].…”

“…35 PA patients including 6 PA/SCS patients underwent AVS to differentiate between unilateral or bilateral aldosterone hypersecretion [12]. To determine the source of aldosterone hypersecretion by AVS, the following diagnostic criteria were used; 1) PAC more than 1400 ng/dL [15], 2) lateralized ratio (LR) defined as the ratio of PAC corrected by cortisol (PAC/F) in the dominant adrenal vein over that in the non-dominant adrenal of dyslipidemia than APA patients.…”