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The performance of left/right adrenal volume ratio and volume difference in predicting unilateral primary aldosteronism

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Abstract

Purpose

The role of computed tomography (CT) in the diagnosis of primary aldosteronism (PA) warrants attention, since the success application of adrenal venous sampling (AVS) remains limited. We aimed to investigate the value of CT-based volumetric indicators, including left-versus-right-adrenal-volume ratio (L/Rv) and left-subtract-right-adrenal-volume difference (L − Rv), in the diagnosis of unilateral primary aldosteronism (UPA).

Methods

A retrospective case–control study included 153 patients with PA and 1272 controls. AVS was used to classify patients into bilateral disease, left-sided disease, and right-sided disease groups.

Results

Adrenal gland volume on both sides of PA patients was significantly larger than controls. The optimal cutoff values of L/Rv and L − Rv were 1.417 [area under the curve (AUC) 0.864] and 1.185 (AUC 0.827), respectively, for the diagnosis of left-sided PA, and 1.030 (AUC 0.767) and 0.220 (AUC 0.769), respectively, for the diagnosis of right-sided PA. The mean AUC for subsequent cross-validation ranged from 0.77 ± 0.03 to 0.86 ± 0.02. Based on the optimal cutoff values, the combination of L/Rv and L − Rv detected 69.6% of patients with left-sided PA and 74.3% of patients with right-sided PA, with a specificity of 93.5% and 89.0%, respectively. For a better clinical application, we reported the sub-optimal cutoffs corresponding to a specificity of 95%. A L/Rv higher than 1.431 and a L − Rv higher than 3.185 as sub-optimal cutoff values was detected in 26.1% of patients with left-sided PA (specificity: 97.2%). A L/Rv smaller than 0.892 and a L − Rv smaller than −0.640 could detect 48.6% of patients with right-sided PA (specificity: 97.5%).

Conclusions

CT-based L/Rv and L − Rv performed well in predicting UPA. The combination of L/Rv and L − Rv may serve as a potential indicator for guiding surgical decision making in centers without AVS programs.

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Availability of data and materials

Data are available upon motivated requests.

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Acknowledgements

The authors gratefully acknowledge the participation of all patients and the grant of the National Nature Science Foundation of China.

Funding

This study was supported by the National Nature Science Foundation of China under Grant (number 81770812 and 81974110).

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Authors and Affiliations

  1. Department of Endocrinology and Metabolism, First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, People’s Republic of China

    W. Zhang, J. Wang, M. Shao, Y. Zhao, H. Ji, F. Guo, Y. Song, X. Fan, F. Wei & G. Qin

  2. Academy of Medical Science, Zhengzhou University, Zhengzhou, Henan Province, People’s Republic of China

    W. Zhang, M. Shao, F. Guo, Y. Song, X. Fan & F. Wei

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Contributions

G-JQ, WZ, JW and M-WS were involved in the development and implementation of the study design and methods and drafting of the paper, revising it critically for intellectual content. All the authors were involved with manuscript preparation, multiple draft revisions, conception of tables, analysis and interpretation of the data and have reviewed and approved the manuscript for submission.

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Correspondence to G. Qin.

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All the procedures involving human participants were performed in accordance with the ethical standard of the Institutional Ethics Committee with which the studies were conducted. This paper does not contain any studies with animals performed by any of the authors.

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The Ethics Committee judged that written informed consent for participation was not required given the non-intrusive and non-experimental character of this study in accordance with the national legislation and the institutional requirements.

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Zhang, W., Wang, J., Shao, M. et al. The performance of left/right adrenal volume ratio and volume difference in predicting unilateral primary aldosteronism. J Endocrinol Invest 46, 687–698 (2023). https://doi.org/10.1007/s40618-022-01912-5

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