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

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

J Clin Endocrinol Metab. 2017 Oct 06;:

Authors: Umakoshi H, Tsuiki M, Takeda Y, Kurihara I, Itoh H, Katabami T, Ichijo T, Wada N, Yoshimoto T, Ogawa Y, Kawashima J, Sone M, Inagaki N, Takahashi K, Watanabe M, Matsuda Y, Kobayashi H, Shibata H, Kamemura K, Otsuki M, Fujii Y, Yamamto K, Ogo A, Yanase T, Suzuki T, Naruse M, JPAS Study Group

Abstract
Context: The number of centers with established adrenal venous sampling (AVS) programs for 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: 1591 PA patients 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 was higher in patients with unilateral disease on CT than those with bilateral normal on CT (50.8% vs. 14.6%, P<0.01) and that was higher in those with hypokalemia than those with normokalemia (58.4% vs. 11.5%, P<0.01). The prevalence and odds ratio for the 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%CI; 3.1-7.2), bilateral-normal on CT with hypokalemia: 38.1% and 9.4 (95%CI; 6.2-14.1), unilateral-disease on CT with hypokalemia: 70.6% and 36.4 (95%CI; 24.7-53.5).
Conclusions: PA Patients with bilateral-normal 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 [PubMed - as supplied by publisher]

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