Endocrine Abstracts

Adrenal venous sampling (AVS) is considered as the gold standard test for primary aldosteronism (PA) subtype diagnosis. However, it is also an invasive and technically challenging procedure. In order to reduce the use of AVS, we propose a new score predicting a unilateral (UPA) or bilateral (BPA) form of PA using biological and radiological parameters. The score was retrospectively developed on a cohort of 72 patients who underwent AVS at the Cliniques Universitaires St-Luc Bruxelles between 1993 and 2021. Based on the AVS, UPA was identified for 51 patients and BPA for 21 patients. Four predictive parameters of uni- or bilateral forms of PA were highlighted by logistic regression analysis and integrated into the KASAI score: minimal serum potassium (<3.0 — 3.0 to 3.4 - >3.4 mmol/l), supine aldosteronemia (<25 - 25 to 45 - >45 ng/dl), aldosteronemia at the end of the saline perfusion test (<20 - 20 to 25 - >25 ng/dl) and the results of the adrenal imaging (no abnormality, unilateral or bilateral abnormality). Depending of the results, 0,1 or 3 points were respectively assigned to each parameter and the sum corresponded to the KASAI score. A score greater than 9/12 identified a unilateral form, a score less than 4/12 a bilateral form, while performing AVS remained indicated for a score between 4 and 9 (grey zone). The KASAI score was calculated for 52 patients in the cohort (some data missing for the others). The score may have avoided the AVS in 40% of the patients (20/52 patients with a score < 4/12 or > 9/12) and correctly identified among them 11 UPA and 8 BPA. Only one UPA patient was falsely identified as BPA. In conclusion, we propose a new clinic-radiological score allowing to bypass AVS in 40 % of the patients with PA. An external validation of the score is however required.