Therapeutic Advances in Endocrinology and Metabolism (Feb 2021)

Primary aldosteronism subtyping in the setting of partially successful adrenal vein sampling

  • Seung-Eun Lee,
  • Sung Woon Park,
  • Min Sun Choi,
  • Gyuri Kim,
  • Jee Hee Yoo,
  • Jiyeon Ahn,
  • Ji Eun Jun,
  • Hong Suk Park,
  • Dongho Hyun,
  • Sung Ki Cho,
  • Seong Eun Ko,
  • Beom-Jun Kim,
  • Jong Woo Kim,
  • Hyun-Ki Yoon,
  • Jung-Min Koh,
  • Seung Hun Lee,
  • Jae Hyeon Kim

DOI
https://doi.org/10.1177/2042018821989239
Journal volume & issue
Vol. 12

Abstract

Read online

Background and aims: Frequent failure of adrenal vein (AV) cannulation is a major obstacle to the universal use of adrenal vein sampling (AVS) for subtyping primary aldosteronism (PA). This study aimed to confirm and modify the value of a previously reported AVS parameter for PA subtyping in the case of cannulation failure on one side. Methods: Successfully catheterized AVS studies in 157 patients (121 patients as a derivation cohort and 36 patients as a validation cohort) from two tertiary hospitals were retrospectively reviewed. The AV/inferior vena cava (IVC) index was defined by dividing the aldosterone/cortisol ratio (ACR) of AV by the ACR of the IVC. Cutoff values for lateralized PA were obtained from two methods: scatterplots and the values corresponding to Youden’s index in receiver operating characteristic (ROC) curves, on the assumption of catheterization failure on one side. Results: Due to multiple samplings in a single AVS procedure, 252 left AV/IVC ratios (LIRs) and 272 right AV/IVC ratios (RIRs) were calculated. Scatterplot cutoffs of LIR >5.4 or 7.0 showed a sensitivity of 55.1% and a specificity of 98.6%. ROC curve cutoffs of LIR ⩽0.8 or >3.1 predicted unilateral PA with a sensitivity of 82.5% and a specificity of 69.6%. ROC curve cutoffs of RIR ⩽0.8 or >3.9 resulted in 87.4% sensitivity and 80.7% specificity. Conclusion: In the case of unilateral AVS failure, the AV/IVC index may help in diagnosing PA subtype.