Impact of different diagnostic criteria during adrenal vein sampling on reproducibility of subtype diagnosis in patients with primary aldosteronism.
In patients with primary aldosteronism, adrenal vein sampling (AVS) is considered the only reliable technique to distinguish between unilateral and bilateral autonomous production of aldosterone, but agreement is lacking on the best criteria indicating successful cannulation and lateralization. The objective of this study was to assess the impact of differing criteria for the successful cannulation and lateralization on the reproducibility of subtype diagnosis. Sixty-two patients with confirmed primary aldosteronism underwent AVS on 2 separate occasions, because the first was unsatisfactory. We compared the different diagnoses of primary aldosteronism subtype reached using AVS data assessed by permissive (type 1), intermediate (type 2), and strict (type 3) criteria. Although 91.1% of all of the (both first and second) AVSs were "successful" by type 1 criteria (50.8% by type 2 and 33.9% by type 3), in only 35.3% of patients was the diagnosis concordant between the first and second AVS. Type 1 criteria also led to a higher rate of diagnosis of unilateral primary aldosteronism (67.3% of successful procedures) than type 2 (36.5%) or type 3 (26.2%). There was considerable disparity in the diagnosis reached using the 3 different criteria, with concordance in only 32.2%. Using either type 1 or 2 criteria, the minimal adrenal/peripheral vein cortisol ratio necessary to obtain the same diagnosis in the first and second AVS procedures was >/=2.75. In conclusion, permissive criteria for successful cannulation and lateralization on AVS achieve poor diagnostic reproducibility and should be avoided.
Mulatero
Paolo
P
Department of Medicine and Experimental Oncology, University of Torino, Torino, Italy. paolo.mulatero@libero.it
Bertello
Chiara
C
Sukor
Norlela
N
Gordon
Richard
R
Rossato
Denis
D
Daunt
Nicholas
N
Leggett
David
D
Mengozzi
Giulio
G
Veglio
Franco
F
Stowasser
Michael
M
D000236:Adenoma / Q000097:blood / Q000175:diagnosis; D000310:Adrenal Gland Neoplasms / Q000097:blood / Q000150:complications / Q000175:diagnosis; D000311:Adrenal Glands / Q000098:blood supply*; D000312:Adrenal Hyperplasia, Congenital / Q000097:blood / Q000150:complications / Q000175:diagnosis; D000450:Aldosterone / Q000097:blood*; D002404:Catheterization / Q000592:standards; D003935:Diagnostic Techniques, Cardiovascular / Q000592:standards*; D003940:Diagnostic Techniques, Endocrine / Q000592:standards*; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D006929:Hyperaldosteronism / Q000097:blood / Q000175:diagnosis* / Q000209:etiology; D006973:Hypertension / Q000097:blood / Q000175:diagnosis* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D014680:Veins
D000450:Aldosterone; D006854:Hydrocortisone