Diagnostic value of unilateral adrenal vein sampling with simple and biochemical/imaging correction: a study on early screening and typing for primary aldosteronism

Adrenal vein sampling (AVS) is the gold standard for distinguishing subtypes for primary aldosteronism. However, its technical challenges and frequent intubation failures pose difficulties. Our study aimed to establish diagnostic models for unilateral primary aldosteronism (UPA) to guide appropriate treatment in early patients. We retrospectively analyzed 274 consecutive patients undergoing AVS without adrenocorticotropic hormone (ACTH) stimulated. We established a diagnostic model corrected by biochemical/imaging, and evaluated the diagnostic value of adrenal vein aldosterone/cortisol concentration (A/C) and its ratio to inferior vena cava (AV/IVC) before and after adjusted. In a population with a median hypertension history of 3.5 years, the area under the curve (AUC) of adrenal vein A/C index for diagnosing ipsilateral and contralateral disease was 0.829 and 0.609, respectively. AUC of AV/IVC was 0.809 and 0.754, respectively. Factors like aldosterone concentration after saline infusion test (SIT), lowest blood potassium, and the presence of consistent adrenal gland nodules on CT were associated with UPA diagnosis, which were therefore included in the diagnostic models. The biochemical/imaging-corrected model correctly classified majority of patients (AUC: 0.828 - 0.893). For diagnosing ipsilateral aldosteronism, when 95% specificity achieved, sensitivities were 60% and 64% in A/C-adjusted and AV/IVC-adjusted models, respectively. As for diagnosing contralateral disease, when 95% specificity achieved, sensitivities were 50% and 53% in A/C-adjusted and AV/IVC-adjusted models, respectively. For early primary aldosteronism patients, the integration of unilaterally adjusted AVS guided by biochemical and imaging indicators into clinical practice is feasible. While it does not play a definitive role, it provides valuable insights to support treatment decisions.