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A Clinical Prediction Score to Diagnose Unilateral Primary Aldosteronism.
MedLine Citation:
PMID:  22918872     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
Context:Adrenal venous sampling is recommended to assess whether aldosterone hypersecretion is lateralized in patients with primary aldosteronism. However, this procedure is invasive, poorly standardized, and not widely available.Objective:Our goal was to identify patients' characteristics that can predict unilateral aldosterone hypersecretion in some patients who could hence bypass adrenal venous sampling before surgery.Design and Setting:A cross-sectional diagnostic study was performed from February 2009 to July 2010 at a single center specialized in hypertension care.Patients:A total of 101 consecutive patients with primary aldosteronism who underwent adrenal venous sampling participated in the study. The autonomy of aldosterone hypersecretion was assessed with the saline infusion test.Intervention:Adrenal venous sampling was performed without ACTH infusion but with simultaneous bilateral sampling.Main Outcome Measures:Variables independently associated with a lateralized adrenal venous sampling in multivariate logistic regression were used to derive a clinical prediction rule.Results:Adrenal venous sampling was successful in 87 patients and lateralized in 49. All 26 patients with a typical Conn's adenoma plus serum potassium of less than 3.5 mmol/liter or estimated glomerular filtration rate of at least 100 ml/min/1.73 m(2) (or both) had unilateral primary aldosteronism; this rule had 100% specificity (95% confidence interval, 91-100) and 53% sensitivity (95% confidence interval, 38-68).Conclusions:If our results are validated on an independent sample, adrenal venous sampling could be omitted before surgery in patients with a typical Conn's adenoma if they meet at least one of two supplementary biochemical characteristics (serum potassium <3.5 mmol/liter or estimated glomerular filtration rate ≥100 ml/min/1.73 m(2)).
Authors:
Elselien M Küpers; Laurence Amar; Alain Raynaud; Pierre-François Plouin; Olivier Steichen
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-8-23
Journal Detail:
Title:  The Journal of clinical endocrinology and metabolism     Volume:  -     ISSN:  1945-7197     ISO Abbreviation:  J. Clin. Endocrinol. Metab.     Publication Date:  2012 Aug 
Date Detail:
Created Date:  2012-8-24     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0375362     Medline TA:  J Clin Endocrinol Metab     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
Assistance Publique-Hôpitaux de Paris (AP-HP), Hypertension Unit (E.M.K., L.A., P.-F.P.), and Cardiovascular Imaging Department (A.R.), Georges Pompidou European Hospital, F-75015 Paris, France; Université Paris-Descartes (P.-F.P.), Faculty of Medicine, F-75006 Paris, France; AP-HP (O.S.), Tenon Hospital, Internal Medicine Department, F-75020 Paris, France; Université Pierre et Marie Curie-Paris 6 (O.S.), Faculty of Medicine, F-75006 Paris, France; and Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche 872 (O.S.), Equipe 20, F-75006 Paris, France.
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