SFEBES2021 Poster Presentations Adrenal and Cardiovascular (45 abstracts)
Clinical prediction scores in primary aldosteronism reliably identify a subset of patients with bilateral disease avoiding the need for adrenal venous sampling
Colin Munro 1 , Scott Akker 1 , Maralyn Druce 1 , Wing-Chiu Sze 1 , Mona Waterhouse 1 , Anju Sahdev 2 , Matthew Matson 2 , Laila Parvanta 3 , William Drake 1 & Sam O’Toole 1,4
1Department of Endocrinology, St Bartholomew’s Hospital, London, United Kingdom; 2Department of Radiology, St Bartholomew’s Hospital, London, United Kingdom; 3Department of Endocrine Surgery, St Bartholomew’s Hospital, London, United Kingdom; 4Department of Endocrinology, The Royal Hallamshire Hospital, Sheffield, United Kingdom
Introduction: Primary aldosteronism (PA) is both the most common form of secondary hypertension and a high-risk subset associated with increased cardiovascular, cerebrovascular and renal morbidity compared to essential hypertension. Unilateral PA is amenable to surgery, biochemical cure and reversal of this excess risk; whilst bilateral disease is best treated through mechanism-directed medical therapy. Currently, PA subtype classification relies on adrenal venous sampling (AVS); an expensive, invasive, and technically demanding procedure to which access is limited. Several clinical scores have been developed to predict PA subtype using standard clinical investigations. These systems were predominantly developed to predict unilateral PA and have not been widely tested outside their original cohorts. In this study, we evaluated the performance of six such systems in predicting bilateral disease with the aim of identifying patients in whom AVS could be avoided.
Methods: Retrospective analysis, in a single tertiary referral centre, of 230 adult PA patients with subtype confirmed via AVS (bilateral) or postoperative biochemical cure (unilateral). Predicted lateralisation was calculated from six published scoring systems and compared to confirmed subtype.
Results: 119 (51.7%) of patients had bilateral disease. Four scoring systems achieved specificity for bilateral disease exceeding 95%.
| Score: | Components: | Specificity [95% CI] | Sensitivity [95% CI] |
| Kamemura 2017 | CT, K, Gender, ARR | 1 [0.97, 1] | 0.03 [0.01, 0.08] |
| Kobayashi 2018 | CT, K, Gender, ARR, PAC | 0.97 [0.92, 0.99] | 0.25 [0.17, 0.33] |
| Küpers 2012 | CT, K, eGFR | 0.98 [0.94, 1] | 0.24 [0.16, 0.32] |
| Umakoshi 2018 | CT, K | 0.96 [0.91, 0.99] | 0.27 [0.19, 0.36] |
Conclusions: Three clinical scores correctly identified a quarter of bilateral PA patients with a low probability (< 5%) of misclassifying those with unilateral disease. Such scores, the simplest comprising only two components, offer significant promise in patient selection and avoiding AVS in those with a very low likelihood of unilateral disease.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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