Endocrine Abstracts

Although the primary aldosteronism (PA) is the most common endocrinological hypertension accounted for approximately 10% of all hypertension population, the subtype classification criteria of adrenal venous samplings (AVS) have been still controversial. Thus, we demonstrated the several different criteria to diagnose the unilateral hyper-aldosteronism (UHA) suspected as adenomas in our series of patients with PA.

This study is included 213 AVS performed PA patients, diagnosed by at least one of the following conformational tests, upright furosemide test, saline infusion test and captopril challenge test, including both UHA and bilateral hyper-aldosteronism (BHA), and 184 AVS succeeded patients were analyzed. We employed as the success criteria of catheterization as selectivity index (SI), calculated by cortisol at each adrenal veins/inferior vena cava (IVC) >2 for before ACTH stimulation and >5 for after. We also employed the criteria for UHA; lateralized ratio (LR) >2 for before stimulation and >4 for the after, calculated by the dominant side of aldosterone/cortisol ratio (A/C) divided by the recessive side of A/C, the contralateral ratio (CR) <1 for both before and after stimulation, calculated by recessive side of A/C divided by A/C at IVC, and the dominant side of aldosterone at adrenal vein (PAC) >1400 ng/dl and ≤1400 ng/dl at the recessive side.

The patients background showed the average age was 56.0±12.1 years old including 72 males and 112 females. Our result showed the prevalence diagnosed as UHA were 58.7, 12.0, 33.7, 15.2, 40.8% for LR>2 without ACTH, LR>4 with ACTH, CR<1 without ACTH, CR<1 with ACTH, and PAC >1400 ng/dl, respectively.

These results clearly demonstrated that subtype diagnosis shows enormous dissociation depending on the decision criteria. The dissociated results of subtype cause profound impact in making decision for the type of therapy. The worldwide standardization of the decision criteria of AVS is required.