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A Novel Method: Super-selective Adrenal Venous Sampling
Published on: September 15, 2017
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Identifying unilateral aldosterone-producing adenomas using published algorithms and imaging: a systematic review and
Elisabeth Ng1,2,3, Stella May Gwini1,4, Winston Zheng2
1Centre for Endocrinology & Reproductive Health, Hudson Institute of Medical Research, Clayton, Australia.
Endocrine Connections
|October 9, 2025
Summary
Algorithms can help identify unilateral primary aldosteronism (PA) without invasive adrenal vein sampling (AVS). This aids in selecting patients for surgery, improving hypertension and cardiovascular disease management.
Area of Science:
- Endocrinology
- Hypertension Research
- Surgical Oncology
Background:
- Primary aldosteronism (PA) is a significant cause of hypertension and cardiovascular disease.
- Unilateral aldosterone-producing adrenal adenomas are potentially curable via surgery.
- Adrenal vein sampling (AVS) is the standard for lateralizing aldosterone excess but is invasive and limited in availability.
Purpose of the Study:
- To evaluate the diagnostic accuracy of published algorithms for lateralizing aldosterone excess without AVS.
- To identify the top-performing algorithms with the highest specificity for unilateral PA.
Main Methods:
- Systematic review and meta-analysis of 43 studies evaluating 30 unique algorithms.
- Algorithms were categorized based on data used: biochemical/radiological/demographic, confirmatory testing, anatomical imaging, or functional imaging.
- Meta-analysis and meta-regression were used to compare aggregated estimates of algorithm performance.
Main Results:
- Algorithms combining biochemical, radiological, and demographic characteristics, or involving confirmatory testing, showed the highest specificity (95%).
- The top-performing algorithm (98% specificity) included CT findings of an adrenal nodule, high plasma aldosterone concentration, hypokalemia, and low renin concentration.
- Anatomical imaging had lower specificity (69%) compared to functional imaging (86%).
Conclusions:
- Algorithms show promise for identifying unilateral PA non-invasively in a subset of patients.
- Widespread adoption requires validation in diverse patient populations.
- These tools can streamline diagnosis, facilitate prompt surgical treatment, and optimize healthcare resource utilization.
