ECE2022 Poster Presentations Adrenal and Cardiovascular Endocrinology (87 abstracts)
The accuracy of adjusted unconventional indices for the assessment of selectivity and lateralization of adrenal vein sampling in the subtype diagnosis of primary aldosteronism
Martina Bollati 1 , Mirko Parasiliti-Caprino 1 , Fabio Bioletto 1 , Filippo Ceccato 2 , Chiara Lopez 1 , Maria Chiara Di Carlo 1 , Giacomo Voltan 2 , Denis Rossato 3 , Giuseppe Giraudo 4 , Carla Scaroni 2 , Ezio Ghigo 1 & Mauro Maccario 1
1City of Health and Science University Hospital, University of Turin, Department of Medical Sciences, Endocrinology, Diabetes and Metabolism, Turin, Italy; 2University-Hospital of Padua, Department of Medicine DIMED, Endocrinology Unit, Padua, Italy; 3City of Health and Science University Hospital, University of Turin, Radiology Unit, Turin, Italy; 4City of Health and Science University Hospital, University of Turin, Surgery, Turin, Italy
Objective: This study aimed to evaluate the performance of simple and clinical/imaging-corrected unconventional indices in predicting the selectivity of adrenal vein sampling (AVS) and the lateralization of aldosterone hypersecretion in patients with primary aldosteronism (PA).
Methods: Data of all consecutive patients with a proven diagnosis of PA who underwent AVS for subtype differentiation in two Italian referral centers were analyzed retrospectively. All patients with confirmed unilateral aldosterone hypersecretion underwent adrenalectomy. For the assessment of lateralization, only bilaterally selective AVS were considered.
Results: AVS was bilaterally selective in 112/144 patients. Unilateral disease was diagnosed in 60 cases (53.6%), whereas idiopathic hyperaldosteronism was diagnosed in 52 individuals (46.4%). The aldosterone index, calculated as the ratio between aldosterone in the adrenal vein and aldosterone in the peripheral blood, showed a high accuracy in predicting selectivity using a cortisol selectivity index of 1.1 as the reference standard, and a moderate accuracy when compared to a cortisol selectivity index cut-off of 2 and 3. The simple aldosterone index also demonstrated a moderate accuracy in predicting ipsilateral and contralateral aldosterone hypersecretion. The monoadrenal index, calculated as the aldosterone-to-cortisol ratio in the adrenal vein, revealed a high accuracy in predicting ipsilateral disease and a high accuracy in predicting contralateral disease, whereas the monolateral index, calculated as the aldosterone-to-cortisol ratio in the adrenal vein vs. peripheral blood, revealed moderate accuracy in predicting ipsilateral disease and high accuracy in predicting contralateral disease. Lesion-side and hypokalemia corrected ROC curves for these unconventional indices revealed a significant improvement in the prediction of ipsi/contralateral disease. For a more straightforward clinical application, we calculated the adjusted cut-offs of covariate-corrected indices in an explicit form, for all possible combinations of lesion side at imaging and presence/absence of hypokalemia, according to the Youden’s criterion and using an optimized specificity. Finally, the comparative aldosterone index, calculated as the ratio between aldosterone in the dominant vs the non-dominant vein, showed a high accuracy in the assessment of lateralization.
Conclusions: In the present study, we demonstrated a satisfactory accuracy of unconventional indices in predicting selectivity and lateralization of aldosterone hypersecretion in the setting of AVS, which became even higher after correction for hypokalemia and lesion side at imaging. After an external validation, these indices may become a useful tool in interpreting AVS results for the subtype diagnosis of PA, thereby allowing the selection of patients for adrenalectomy, when standard indices cannot be performed.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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