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J Clin Endocrinol Metab. 2018 Mar 1;103(3):900-908. doi: 10.1210/jc.2017-01774.

Significance of Computed Tomography and Serum Potassium in Predicting Subtype Diagnosis of Primary Aldosteronism.

Author information

1
Department of Endocrinology and Metabolism, National Hospital Organization Kyoto Medical Center, Kyoto, Japan.
2
Department of Internal Medicine, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan.
3
Department of Endocrinology, Metabolism and Nephrology, School of Medicine, Keio University, Tokyo, Japan.
4
Division of Metabolism and Endocrinology, Department of Internal Medicine, St. Marianna University School of Medicine Yokohama City Seibu Hospital, Yokohama, Japan.
5
Department of Endocrinology and Metabolism, Saiseikai Yokohamashi Tobu Hospital, Yokohama, Japan.
6
Department of Diabetes and Endocrinology, Sapporo City General Hospital, Sapporo, Japan.
7
Department of Molecular Endocrinology and Metabolism, Tokyo Medical and Dental University, Tokyo, Japan.
8
Department of Metabolic Medicine, Faculty of Life Science, Kumamoto University, Kumamoto University, Kumamoto, Japan.
9
Department of Diabetes, Endocrinology and Nutrition Kyoto University, Kyoto, Japan.
10
Division of Nephrology and Endocrinology, University of Tokyo School of Medicine, Tokyo, Japan.
11
Division of Metabolism, Showa General Hospital, Tokyo, Japan.
12
Department of Endocrinology and Diabetes, Okazaki City Hospital, Okazaki, Japan.
13
Department of Cardiology, Sanda City Hospital, Sanda, Japan.
14
Division of Nephrology, Hypertension and Endocrinology, Nihon University School of Medicine, Tokyo, Japan.
15
Department of Endocrinology, Metabolism, Rheumatology and Nephrology, Faculty of Medicine, Oita University, Yufu, Japan.
16
Department of Cardiology, Akashi Medical Center, Akashi, Japan.
17
Department of Metabolic Medicine, Osaka University Graduate School of Medicine, Osaka, Japan.
18
Department of Cardiology, JR Hiroshima Hospital, Hiroshima, Japan.
19
Department of Geriatric and General Medicine, Osaka University Graduate School of Medicine, Osaka, Japan.
20
Clinical Research Institute, National Hospital Organization Kyusyu Medical Center, Fukuoka, Japan.
21
Department of Endocrinology and Diabetes Mellitus, Faculty of Medicine, Fukuoka University, Fukuoka, Japan.
22
Department of Public Health, School of Medicine, International University of Health and Welfare, Narita, Japan.

Abstract

Context:

The number of centers with established adrenal venous sampling (AVS) programs for the subtype diagnosis of primary aldosteronism (PA) is limited.

Objective:

Aim was to develop an algorithm for AVS based on subtype prediction by computed tomography (CT) and serum potassium.

Design:

A multi-institutional retrospective cohort study in Japan.

Patients:

A total of 1591 patients with PA were classified into four groups according to CT findings and potassium status. Subtype diagnosis of PA was determined by AVS.

Main Outcome Measure:

Prediction value of the combination of CT findings and potassium status for subtype diagnosis.

Results:

The percentages of unilateral hyperaldosteronism on AVS were higher in patients with unilateral disease on CT than those with bilateral normal results on CT (50.8% vs 14.6%, P < 0.01), and these percentages were higher in those with hypokalemia than those with normokalemia (58.4% vs 11.5%, P < 0.01). The prevalence and odds ratio for unilateral hyperaldosteronism on AVS were as follows: bilateral normal on CT with normokalemia, 6.2% (reference); unilateral disease on CT with normokalemia, 23.8% and 4.8 [95% confidence interval (CI), 3.1 to 7.2]; bilateral normal on CT with hypokalemia, 38.1% and 9.4 (95% CI, 6.2 to 14.1), and unilateral disease on CT with hypokalemia, 70.6% and 36.4 (95% CI, 24.7 to 53.5).

Conclusions:

Patients with PA with bilateral normal results on CT and normokalemia likely have a low prior probability of a lateralized form of AVS and could be treated medically, whereas those with unilateral disease on CT and hypokalemia have a high probability of a lateralized form of AVS.

PMID:
29092077
DOI:
10.1210/jc.2017-01774
[Indexed for MEDLINE]

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