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

PurposeTo evaluate whether the clinical, biochemical and radiological features of patients with primary aldosteronism (PA) can predict both main subtypes of PA.MethodsA retrospective multicenter study of PA patients followed in 27 Spanish tertiary hospitals (SPAIN-ALDO Register). Only patients with...

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Autores: Parra Ramírez, Paola, Martín Rojas-Marcos, Patricia, Paja Fano, Miguel, González Boillos, Marga, Pla Peris, Begoña, Pascual Corrales, Eider, García Cano, Ana María, Ruiz-Sánchez, Jorge Gabriel, Vicente Delgado, Almudena, Gómez Hoyos, Emilia, Ferreira, Rui, García Sanz, Iñigo, Recasens Sala, Mònica, Barahona San Millán, Rebeca, Picón César, María José, Díaz Guardiola, Patricia, Perdomo, Carolina M., Manjón Miguélez, Laura, García Centeno, Rogelio, Percovich Hualpa, Juan Carlos, Rebollo Román, Ángel, Gracia Gimeno, Paola, Robles Lázaro, Cristina, Morales Ruiz, Manuel, Calatayud Gutiérrez, María, Furio Collao, Simone Andree, Meneses, Diego, Sampedro Núñez, Miguel Antonio, Escudero Quesada, Verónica, Mena Ribas, Elena, Sanmartín Sánchez, Alicia, Gonzalvo Díaz, César, Lamas Oliveira, Cristina, Guerrero Vázquez, Raquel, Castillo Tous, María del, Serrano Gotarredona, Joaquín, Michalopoulou Alevras, Theodora, Moya Mateo, Eva María, Hanzu, Felicia Alexandra, Araujo Castro, Marta
Tipo de recurso: artículo
Fecha de publicación:2023
País:España
Institución:Universidad de Castilla-La Mancha
Repositorio:RUIdeRA. Repositorio Institucional de la UCLM
OAI Identifier:oai:ruidera.uclm.es:10578/42704
Acceso en línea:https://hdl.handle.net/10578/42704
Access Level:acceso abierto
Palabra clave:Adrenal venous sampling
Cerebrovascular disease
Dyslipidemia
Primary aldosteronism
Sleep apnea syndrome
Sub-typing
Descripción
Sumario:PurposeTo evaluate whether the clinical, biochemical and radiological features of patients with primary aldosteronism (PA) can predict both main subtypes of PA.MethodsA 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.Results328 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%).ConclusionA 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.

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