title: Significance of adrenal computed tomography in predicting laterality and indicating adrenal vein sampling in primary aldosteronism.
abstract: Although laterality assessed by computed tomography (CT) in primary aldosteronism (PA) is not always concordant with that assessed by adrenal vein sampling (AVS), it is unclear whether all patients diagnosed with PA should undergo AVS for subtype classification. The aim of the current study was to investigate the accuracy of CT in subtype classification and to develop a prediction score for bilateral subtype in patients without adrenal tumour. As part of the WAVES-J study, 393 patients with PA were analysed. Subtyping using CT was concordant with that using AVS in 68% (269/393) of patients in the total sample, and in 38% (68/156) of patients with unilateral tumours, 56% (5/9) of patients with bilateral tumours and 89% (204/228) of patients without tumour. In patients without tumour, female gender, plasma aldosterone concentration (pg ml-1) to plasma renin activity ratio ⩽550 and serum potassium ⩾3.8 mEq l-1were shown to be independent predictors for bilateral subtype. A prediction score based on these three variables was constructed with one point attributed to each variable. A score of three points had 29% sensitivity and 96% specificity in a receiver operating characteristic curve analysis. The results suggest that although CT is not sufficiently accurate for subtype classification in patients with adrenal tumours, it is sufficient to determine bilateral subtype in patients without tumour. Moreover, using our clinical prediction score in patients without tumour could be useful in determining the necessity of AVS for subtype classification.
authors: Department of Cardiology, Akashi Medical Center, Akashi, Japan.
authors: K
authors: K
authors: Kamemura
authors: Department of Diabetes and Endocrinology, Sapporo City General Hospital, Sapporo, Japan.
authors: N
authors: N
authors: Wada
authors: Department of Diabetes and Endocrinology, Saiseikai Yokohama City Toubu Hospital, Yokohama, Japan.
authors: T
authors: T
authors: Ichijo
authors: Department of Cardiology, Sanda City Hospital, Sanda, Japan.
authors: Y
authors: Y
authors: Matsuda
authors: Department of Cardiology, Hiroshima General Hospital of West Japan Railway Company, Hiroshima, Japan.
authors: Y
authors: Y
authors: Fujii
authors: Department of Cardiology, Saiseikai Tondabayashi Hospital, Tondabayashi, Japan.
authors: T
authors: T
authors: Kai
authors: Department of Internal Medicine, Matsuyama Red Cross Hospital, Matsuyama, Japan.
authors: T
authors: T
authors: Fukuoka
authors: Department of Metabolism and Endocrinology, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan.
authors: R
authors: R
authors: Sakamoto
authors: Department of Metabolism and Endocrinology, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan.
authors: A
authors: A
authors: Ogo
authors: Department of Public Health, Kitasato University School of Medicine, Tokyo, Japan.
authors: T
authors: T
authors: Suzuki
authors: Department of Endocrinology, Metabolism, and Hypertension, Clinical Research Institute, National Hospital Organization Kyoto Medical Center, Kyoto, Japan.
authors: H
authors: H
authors: Umakoshi
authors: Department of Endocrinology, Metabolism, and Hypertension, Clinical Research Institute, National Hospital Organization Kyoto Medical Center, Kyoto, Japan.
authors: M
authors: M
authors: Tsuiki
authors: Department of Endocrinology, Metabolism, and Hypertension, Clinical Research Institute, National Hospital Organization Kyoto Medical Center, Kyoto, Japan.
authors: M
authors: M
authors: Naruse
mesh_terms: D000311:Adrenal Glands / Q000000981:diagnostic imaging*; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D006929:Hyperaldosteronism / Q000145:classification / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed