A subtype prediction score for primary aldosteronism.
Primary aldosteronism (PA) is the most common cause of endocrine hypertension. Although adrenal venous sampling (AVS) is recommended as the gold standard procedure for subtype classification in PA, it is a specialized technique with limited availability. The objective of this study was to develop a scoring system that predicted PA subtype using clinical characteristics. Seventy-one patients with PA were studied. The subjects were diagnosed as having either unilateral (n=32) or bilateral disease (n=39) based on AVS, surgery and/or the postoperative clinical course. Variables associated with laterality in the univariate analysis were entered into multivariable logistic regression models and the regression coefficients were used to construct a subtype prediction score. The diagnostic significance of the score was then evaluated using receiver operating characteristic (ROC) curve analysis. The subtype prediction score was calculated as follows: serum potassium ⩽3.4 mEq l(-1), 2 points; plasma aldosterone concentration ⩾165 pg ml(-1), 3 points; and aldosterone to renin ratio ⩾1000 in a post-captopril challenge test (plasma renin activity in ng ml(-1) h(-1)), 3 points. ROC curve analysis for the ability to discriminate between unilateral and bilateral PA showed that a score of 5 points had 75% sensitivity and 95% specificity, and a score of 3 points had a sensitivity of 97% and a specificity of 59%. The area under the ROC curve was 0.920 (95% confidence interval, 0.859-0.979). Our subtype prediction score could discriminate between unilateral and bilateral PA and is useful for selecting patients who should undergo AVS before surgery.
Department of Endocrinology, Metabolism and Hypertension, National Hospital Organization Kyoto Medical Center, Kyoto, Japan.
K
K
Nanba
Department of Endocrinology, Metabolism and Hypertension, National Hospital Organization Kyoto Medical Center, Kyoto, Japan.
M
M
Tsuiki
Department of Endocrinology, Metabolism and Hypertension, National Hospital Organization Kyoto Medical Center, Kyoto, Japan.
K
K
Nakao
Department of Endocrinology, Metabolism and Hypertension, National Hospital Organization Kyoto Medical Center, Kyoto, Japan.
A
A
Nanba
Department of Endocrinology, Metabolism and Hypertension, National Hospital Organization Kyoto Medical Center, Kyoto, Japan.
T
T
Usui
Department of Endocrinology, Metabolism and Hypertension, National Hospital Organization Kyoto Medical Center, Kyoto, Japan.
T
T
Tagami
Department of Radiology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan.
Y
Y
Hirokawa
Department of Urology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan.
H
H
Okuno
Department of Clinical Research and Informatics, National Center for Global Health and Medicine, Tokyo, Japan.
T
T
Suzuki
Department of Clinical Research and Informatics, National Center for Global Health and Medicine, Tokyo, Japan.
T
T
Shimbo
Department of Endocrinology, Metabolism and Hypertension, National Hospital Organization Kyoto Medical Center, Kyoto, Japan.
A
A
Shimatsu
Department of Endocrinology, Metabolism and Hypertension, National Hospital Organization Kyoto Medical Center, Kyoto, Japan.
M
M
Naruse
D000328:Adult; D000450:Aldosterone / Q000097:blood; D005260:Female; D005544:Forecasting; D006801:Humans; D006929:Hyperaldosteronism / Q000145:classification* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011188:Potassium / Q000097:blood; D012372:ROC Curve; D012044:Regression Analysis; D012083:Renin / Q000097:blood
D000450:Aldosterone; D012083:Renin; D011188:Potassium