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A Novel Method: Super-selective Adrenal Venous Sampling
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Predicting Unilateral Aldosterone Secretion in Primary Aldosteronism.
Elias Mimouni1, Wajid Amjad1, Jesse E Passman1
1Division of Endocrine and Oncologic Surgery, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
The Journal of Surgical Research
|January 1, 2025
Summary
Clinical factors can help predict unilateral primary aldosteronism, a potentially curable condition. A high clinical risk score strongly suggests a unilateral source, guiding treatment decisions for resistant hypertension.
Area of Science:
- Endocrinology
- Hypertension Research
- Surgical Endocrinology
Background:
- Primary aldosteronism (PA) affects 20% of patients with resistant hypertension.
- Unilateral PA is potentially curable via adrenalectomy.
- Adrenal vein sampling (AVS) is definitive for subtype differentiation but not universally accessible.
Purpose of the Study:
- To assess if clinical characteristics can predict unilateral aldosterone secretion on AVS.
- To develop a clinical risk score for predicting unilateral PA.
Main Methods:
- Retrospective analysis of 461 patients with biochemically diagnosed PA who underwent AVS (1998-2019).
- Univariate and multivariate logistic regression to identify predictors of unilateral secretion (lateralization index ≥4).
- Development and validation of a clinical risk score.
Main Results:
- 324 out of 461 patients (70%) had unilateral aldosterone secretion.
- Predictors of unilateral PA included non-Black race, lower BMI, shorter hypertension duration, and nonincidental diagnosis.
- Clinical risk score achieved 86% positive predictive value for unilateral disease.
Conclusions:
- Clinical factors alone imperfectly predict PA subtypes.
- High clinical risk scores offer strong positive predictive value for identifying unilateral PA, aiding in treatment selection.
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