Surgical decision in patients with primary aldosteronism based on adrenal veins aldosterone not corrected by cortisol

Cortisol-corrected aldosterone concentration is used to interpret adrenal venous sampling (AVS) results to identify the subtype of primary aldosteronism. Whether AVS could be interpreted using aldosterone without cortisol correction is unclear.

To evaluate the accuracy of plasma aldosterone concentration (PAC) and aldosterone ratio (PAC of the higher side divided by PAC of the lower side) of the adrenal veins for the diagnosis of unilateral PA (UPA).

A retrospective study was conducted in PA patients who underwent bilaterally successful AVS. Area under the receiver operating characteristic curve (AUC), specificity and sensitivity of PAC and aldosterone ratio of adrenal veins in non-stimulated and adrenocorticotropic hormone (ACTH) - stimulated AVS were calculated.

323 patients with UPA and 122 with bilateral PA were included. Under non-ACTH stimulated AVS, AUC of PAC and aldosterone ratio to diagnose UPA were 0.86 (95%CI 0.83-0.89) and 0.84 (95%CI 0.80-0.88), respectively. The specificity was 90%, with sensitivity of 59%, when using PAC cutoff of 1012.8 ng/dL to diagnose UPA. The specificity was 90%, with sensitivity of 65%, when using aldosterone ratio cutoff of 6.84 to diagnose UPA. Under ACTH stimulated AVS, PAC and aldosterone ratio showed similar accuracy to diagnose UPA. The specificity was 90%, with sensitivity of 60%, when using PAC cutoff of 4008.3 ng/dL to diagnose UPA. The specificity was 90%, with sensitivity of 80%, when using aldosterone ratio cutoff of 4.77 to diagnose UPA.

PAC and aldosterone ratio of the adrenal veins can be used to diagnose UPA during non-stimulated and ACTH-stimulated AVS.