Significance of computed tomography and serum potassium in predicting subtype diagnosis of primary aldosteronism

Hironobu Umakoshi, Mika Tsuiki, Yoshiyu Takeda, Isao Kurihara, Hiroshi Itoh, Takuyuki Katabami, Takamasa Ichijo, Norio Wada, Takanobu Yoshimoto, Yoshihiro Ogawa, Junji Kawashima, Masakatsu Sone, Nobuya Inagaki, Katsutoshi Takahashi, Minemori Watanabe, Yuichi Matsuda, Hiroki Kobayashi, Hirotaka Shibata, Kohei Kamemura, Michio OtsukiYuichi Fujii, Koichi Yamamto, Atsushi Ogo, Toshihiko Yanase, Tomoko Suzuki, Mitsuhide Naruse, Study Group JPAS Study Group

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Abstract

Context: The number of centers with established adrenal venous sampling (AVS) programs for the subtype diagnosis of primary aldosteronism (PA) is limited. Objective: Aim was to develop an algorithm for AVS based on subtype prediction by computed tomography (CT) and serum potassium. Design: A multi-institutional retrospective cohort study in Japan. Patients: A total of 1591 patients with PA were classified into four groups according to CT findings and potassium status. Subtype diagnosis of PA was determined by AVS. Main Outcome Measure: Prediction value of the combination of CT findings and potassium status for subtype diagnosis. Results: The percentages of unilateral hyperaldosteronism on AVS were higher in patients with unilateral disease on CT than those with bilateral normal results on CT (50.8% vs 14.6%, P, 0.01), and these percentages were higher in those with hypokalemia than those with normokalemia (58.4% vs 11.5%, P, 0.01). The prevalence and odds ratio for unilateral hyperaldosteronism on AVS were as follows: bilateral normal on CT with normokalemia, 6.2% (reference); unilateral disease on CT with normokalemia, 23.8% and 4.8 [95% confidence interval (CI), 3.1 to 7.2]; bilateral normal on CT with hypokalemia, 38.1% and 9.4 (95% CI, 6.2 to 14.1), and unilateral disease on CT with hypokalemia, 70.6% and 36.4 (95% CI, 24.7 to 53.5). Conclusions: Patients with PA with bilateral normal results on CT and normokalemia likely have a low prior probability of a lateralized form of AVS and could be treated medically, whereas those with unilateral disease on CT and hypokalemia have a high probability of a lateralized form of AVS.

Original languageEnglish
Pages (from-to)900-908
Number of pages9
JournalJournal of Clinical Endocrinology and Metabolism
Volume103
Issue number3
DOIs
Publication statusPublished - 2018 Jan 1

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ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism
  • Biochemistry
  • Endocrinology
  • Clinical Biochemistry
  • Biochemistry, medical

Cite this

Umakoshi, H., Tsuiki, M., Takeda, Y., Kurihara, I., Itoh, H., Katabami, T., Ichijo, T., Wada, N., Yoshimoto, T., Ogawa, Y., Kawashima, J., Sone, M., Inagaki, N., Takahashi, K., Watanabe, M., Matsuda, Y., Kobayashi, H., Shibata, H., Kamemura, K., ... JPAS Study Group, S. G. (2018). Significance of computed tomography and serum potassium in predicting subtype diagnosis of primary aldosteronism. Journal of Clinical Endocrinology and Metabolism, 103(3), 900-908. https://doi.org/10.1210/jc.2017-01774