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27-03-2024 | Original Article

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

Authors: Tugba Barlas, Erhan Turgut Ilgit, Mehmet Koray Akkan, Emetullah Cindil, Isil Imge Gultekin, Hulya Nur Sodan, Mehmet Muhittin Yalcin, Ethem Turgay Cerit, Sinan Sozen, Mujde Akturk, Fusun Toruner, Ayhan Karakoc, Alev Eroglu Altinova

Published in: Hormones

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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Title: Clinical prediction model for primary aldosteronism subtyping and special focus on adrenal volumetric assessment
Authors: Tugba Barlas
Erhan Turgut Ilgit
Mehmet Koray Akkan
Emetullah Cindil
Isil Imge Gultekin
Hulya Nur Sodan
Mehmet Muhittin Yalcin
Ethem Turgay Cerit
Sinan Sozen
Mujde Akturk
Fusun Toruner
Ayhan Karakoc
Alev Eroglu Altinova
Publication date: 27-03-2024
Publisher: Springer International Publishing
Published in: Hormones
Print ISSN: 1109-3099
Electronic ISSN: 2520-8721
DOI: https://doi.org/10.1007/s42000-024-00548-9

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