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J Clin Endocrinol Metab. 2012 Oct;97(10):3530-7. doi: 10.1210/jc.2012-1917. Epub 2012 Aug 23.

A clinical prediction score to diagnose unilateral primary aldosteronism.

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1
Assistance Publique-Hôpitaux de Paris, Hypertension Unit, and Université Paris-Descartes, Faculty of Medicine, 4 rue de la Chine, F-75020 Paris, France.

Abstract

CONTEXT:

Adrenal venous sampling is recommended to assess whether aldosterone hypersecretion is lateralized in patients with primary aldosteronism. However, this procedure is invasive, poorly standardized, and not widely available.

OBJECTIVE:

Our goal was to identify patients' characteristics that can predict unilateral aldosterone hypersecretion in some patients who could hence bypass adrenal venous sampling before surgery.

DESIGN AND SETTING:

A cross-sectional diagnostic study was performed from February 2009 to July 2010 at a single center specialized in hypertension care.

PATIENTS:

A total of 101 consecutive patients with primary aldosteronism who underwent adrenal venous sampling participated in the study. The autonomy of aldosterone hypersecretion was assessed with the saline infusion test.

INTERVENTION:

Adrenal venous sampling was performed without ACTH infusion but with simultaneous bilateral sampling.

MAIN OUTCOME MEASURES:

Variables independently associated with a lateralized adrenal venous sampling in multivariate logistic regression were used to derive a clinical prediction rule.

RESULTS:

Adrenal venous sampling was successful in 87 patients and lateralized in 49. All 26 patients with a typical Conn's adenoma plus serum potassium of less than 3.5 mmol/liter or estimated glomerular filtration rate of at least 100 ml/min/1.73 m2 (or both) had unilateral primary aldosteronism; this rule had 100% specificity (95% confidence interval, 91-100) and 53% sensitivity (95% confidence interval, 38-68).

CONCLUSIONS:

If our results are validated on an independent sample, adrenal venous sampling could be omitted before surgery in patients with a typical Conn's adenoma if they meet at least one of two supplementary biochemical characteristics (serum potassium<3.5 mmol/liter or estimated glomerular filtration rate ≥100 ml/min/1.73 m2).

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PMID:
22918872
DOI:
10.1210/jc.2012-1917
[Indexed for MEDLINE]
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