Key result
An aldosterone to renin ratio > 10 (ng/dL)/(mU/L) after confirmatory testing predicted adrenal lateralization with 100% specificity and was associated with increased cardiorenal damage.
Why the study?
PA patients without APA frequently have unilateral aldosterone hypersecretion and risk inappropriate adrenalectomy without AVS, making it necessary to identify clinical characteristics that warrant recommending AVS.
Does an aldosterone to renin ratio (ARR) > 10 (ng/dL)/(mU/L) after confirmatory testing predict adrenal laterality and target organ damage in patients with primary aldosteronism without adenomas?
Observational (n=141)
No
Does an aldosterone to renin ratio (ARR) > 10 (ng/dL)/(mU/L) after confirmatory testing predict adrenal laterality and target organ damage in patients with primary aldosteronism without adenomas?
Odds Ratio: 1.01 (95% CI 1–1.021)
p-value: p=0.044
In patients with primary aldosteronism without adenomas, an aldosterone to renin ratio > 10 after confirmatory testing is highly specific for unilateral adrenal hypersecretion and is associated with increased cardiorenal damage, indicating a strong need for adrenal vein sampling.
Clinical features may identify PA patients without APA needing AVS to avoid inappropriate surgery; leaves open need for validation before practice change.
BACKGROUND: Primary aldosteronism (PA) is highly prevalent in hypertensive population. Adrenal vein sampling (AVS) is the only procedure to assess adrenal aldosterone hypersecretion in PA. PA patients without aldosterone-producing adenomas (APA) frequently have unilateral aldosterone hypersecretion (UAH). These patients could bear inappropriate adrenalectomy without AVS. This study aims to identify which clinical characteristics should be recommended to perform AVS in these PA patients. METHODS: This study was performed from January 2018 to July 2019 at a center for hypertension and metabolic diseases. Adrenal computed tomography (CT) scan, biochemical evaluation, and AVS were performed. RESULTS: Total 141 patients were included in this study. Aldosterone to renin ratio (ARR) after confirmatory test is highly associated with adrenal laterality. The specificity of ARR > 10 (ng/dL)/(mU/L) after confirmatory test is 100%. After confirmatory test, patients with ARR > 10 (ng/dL)/(mU/L) had higher plasma aldosterone concentration and incidences of ischemic heart diseases and renal damage(p < 0.05). CONCLUSIONS: After confirmatory tests, ARR > 10 (ng/dL)/(mU/L) indicates adrenal laterality, with increasingly cardiorenal damage in PA patients without APA. Thus, AVS should be recommended in these patients before surgery. TRIAL REGISTRATION: NCT03398785 , Date of Registration: December 24, 2017.
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Sun et al. (2021) conducted an observational in Primary aldosteronism without aldosterone-producing adenomas (n=141). Aldosterone to renin ratio (ARR) after confirmatory test vs. Lower ARR was evaluated on Adrenal lateralization (unilateral aldosterone hypersecretion) (OR 1.010, 95% CI 1.000-1.021, p=0.044). An aldosterone to renin ratio > 10 (ng/dL)/(mU/L) after confirmatory testing predicted adrenal lateralization with 100% specificity and was associated with increased cardiorenal damage.
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