Key result
The combination of unilateral lesions on computed tomography and hypokalemia was significantly associated with an increased prevalence of unilateral primary aldosteronism (OR 1.537), with the predictive value being stronger in men.
Why the study?
The predictive value of CT findings combined with serum potassium levels for primary aldosteronism subtype diagnosis, particularly regarding sex differences, was not well established.
Does the combination of CT findings and serum potassium predict unilateral primary aldosteronism on AVS in patients with primary aldosteronism?
Observational (n=482)
No
Does the combination of CT findings and serum potassium predict unilateral primary aldosteronism on AVS in patients with primary aldosteronism?
Odds Ratio: 1.537 (95% CI 1.364–1.731)
p-value: p=<0.001
CT findings combined with serum potassium levels are valuable for predicting the subtype of primary aldosteronism, with the predictive value being significantly stronger in men than in women.
CT plus potassium may aid PA subtyping, especially in men; leaves open prospective validation before reducing AVS reliance.
Objective We aimed to investigate the predictive value of the CT findings combined with serum potassium levels for primary aldosteronism (PA) subtype diagnosis, with a particular interest in sex differences. Methods In this retrospective study, we eventually included 482 PA patients who underwent successful adrenal venous sampling (AVS) and had available data. We diagnosed the subjects as having either unilateral (n = 289) or bilateral PA (n = 193) based on AVS. We analyzed the concordance rate between AVS and adrenal CT combined with serum potassium and performed a logistic regression analysis to assess the prevalence of unilateral PA on AVS. Results The total diagnostic concordance rate between CT findings and AVS was 51.5% (248/482). The prevalence of hypokalemia in men and women was 47.96% (129/269) and 40.85% (87/213), respectively. The occurrence of unilateral lesions on CT and hypokalemia was significantly associated with an increased prevalence of unilateral PA [odds ratio (OR) 1.537; 95% confidence interval (CI) 1.364–1.731; p < 0.001]. In male participants, G2 (bilateral lesion on CT and normokalemia), G3 (unilateral lesion on CT and normokalemia), G4 (bilateral normal on CT and hypokalemia), G5 (bilateral lesion on CT and hypokalemia), and G6 (unilateral lesion on CT and hypokalemia) were significantly increased for the prevalence of unilateral PA on AVS (G2: OR 4.620, 95% CI 1.408–15.153; G3: OR 6.275, 95% CI 2.490–15.814; G4: OR 3.793, 95% CI 1.191–12.082; G5: OR 16.476, 95% CI 4.531–59.905; G6: OR 20.101, 95% CI 7.481–54.009; all p < 0.05), compared with G1 (patients with bilateral normal on CT and normokalemia). However, among female participants, we found an increased likelihood for unilateral PA in patients with unilateral lesions on CT and hypokalemia alone (OR 10.266, 95% CI 3.602–29.259, p < 0.001), while no associations were found in other groups (all p > 0.05). Sex had a significant effect on modifying the relationship between unilateral PA and the combination of CT findings and serum potassium ( p for interaction <0.001). Conclusion In conclusion, our results indicated that CT findings combined with serum potassium levels have a great value for predicting the subtype of PA and are stronger in men.
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Wu et al. (2023) conducted an observational in Primary aldosteronism (n=482). Computed tomography findings combined with serum potassium levels vs. Bilateral normal on CT and normokalemia was evaluated on Prevalence of unilateral primary aldosteronism on adrenal venous sampling (OR 1.537, 95% CI 1.364-1.731, p=<0.001). The combination of unilateral lesions on computed tomography and hypokalemia was significantly associated with an increased prevalence of unilateral primary aldosteronism (OR 1.537), with the predictive value being stronger in men.
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