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Clinical prediction model for primary aldosteronism subtyping and special focus on adrenal volumetric assessment

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Abstract

Purpose

Our aim was to develop a prediction model based on a simple score with clinical, laboratory, and imaging findings for the subtype diagnosis of primary aldosteronism (PA). The contribution of adrenal volumetric assessment to PA subtyping was also investigated.

Methods

Thirty-five patients with adequate cannulation in adrenal venous sampling (AVS) were included. Laboratory data, the saline infusion test (SIT), and the AVS results of patients with PA were retrospectively evaluated. Volumetric assessment was performed using magnetic resonance imaging (MRI) and the ratio of adrenal volumes was calculated after adjusting for gender- and side-specific mean reference values of both adrenal glands.

Results

The AVS was consistent with unilateral PA in 49% and bilateral in 51% of the patients. Hypertension as a reason for work-up, the highest aldosterone/lowest potassium value higher than 12, the percentage of plasma aldosterone concentration (PAC) reduction after SIT by equal or less than 43.5%, the use of oral potassium replacement, unilateral disease at pre-AVS imaging, and a ratio of adjusted adrenal volumes equal to or below 1.7 were indicative of unilateral disease in univariate logistic regression analysis concerning the distinction of PA subtyping (p < 0.05). Multivariate logistic regression analysis also revealed that adrenal volumetric assessment has an impact on PA subtyping (p < 0.05). In the prediction model, when each of the six parameters that were significant in the univariate logistic regression analysis was assigned one point, < 4 predicted bilateral PA, whereas ≥ 4 predicted unilateral PA (AUC:0.92, p < 0.001).

Conclusion

This prediction model before AVS may serve as a convenient and practical approach, while an adjusted adrenal volumetric assessment can make a positive contribution to PA subtyping.

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Funding

No funding was received for conducting this study.

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Authors and Affiliations

  1. Faculty of Medicine, Department of Endocrinology and Metabolism, Gazi University, Ankara, Turkey

    Tugba Barlas, Hulya Nur Sodan, Mehmet Muhittin Yalcin, Ethem Turgay Cerit, Mujde Akturk, Fusun Toruner, Ayhan Karakoc & Alev Eroglu Altinova

  2. Faculty of Medicine, Department of Radiology, Gazi University, Ankara, Turkey

    Erhan Turgut Ilgit, Mehmet Koray Akkan, Emetullah Cindil & Isil Imge Gultekin

  3. Faculty of Medicine, Department of Urology, Gazi University, Ankara, Turkey

    Sinan Sozen

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  1. Tugba Barlas
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Correspondence to Tugba Barlas.

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Ethical approval

This study was approved by the local Ethical Board of Gazi University (Ethics approval number: 924) and conducted according to the Declaration of Helsinki. Informed consent has been obtained from all patients for the AVS procedure since they were registered in the interventional radiology department.

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Barlas, T., Ilgit, E., Akkan, M. et al. Clinical prediction model for primary aldosteronism subtyping and special focus on adrenal volumetric assessment. Hormones (2024). https://doi.org/10.1007/s42000-024-00548-9

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