Key result
The comparative aldosterone index (CAI) demonstrated high diagnostic accuracy in predicting unilateral primary aldosteronism with an AUC of 0.92.
Why the study?
The reliability of simple and corrected aldosterone indices for assessing selectivity and lateralization of AVS in primary aldosteronism required evaluation.
Do simple and corrected aldosterone indices accurately predict selectivity and lateralization of adrenal vein sampling in patients with primary aldosteronism?
Observational (n=144)
Yes
Do simple and corrected aldosterone indices accurately predict selectivity and lateralization of adrenal vein sampling in patients with primary aldosteronism?
Effect estimate: AUC 0.92 (95% CI 0.87-0.96)
Simple and clinical-/imaging-corrected aldosterone indices demonstrate high diagnostic accuracy for assessing selectivity and lateralization during adrenal vein sampling in primary aldosteronism, offering an alternative when standard indices cannot be used.
Indices may aid AVS selectivity assessment in primary aldosteronism; leaves open need for prospective validation before clinical adoption.
OBJECTIVE: This study aimed to evaluate the reliability of simple and corrected aldosterone indices for assessing the selectivity and lateralization of adrenal vein sampling (AVS) in patients with primary aldosteronism. METHODS: Data of all consecutive patients with primary aldosteronism who underwent AVS for subtype diagnosis, followed at two Italian referral centers, were analyzed retrospectively. RESULTS: AVS achieved bilateral selectivity in 112/144 patients. Unilateral disease was diagnosed in 60 cases (53.6%) and idiopathic hyperaldosteronism in 52 individuals (46.4%). The aldosterone index (aldosterone ratio between an adrenal vein and the inferior vena cava) showed a high accuracy in predicting selectivity, compared to a cortisol selectivity index of 1.1, and a moderate accuracy, compared to cortisol cut-offs of 2 and 3. The simple aldosterone index showed a moderate accuracy in predicting ipsi/contralateral aldosterone hypersecretion, while lesion side- and hypokalemia-corrected aldosterone index revealed a significant improvement in predicting ipsi/contralateral disease. Moreover, the comparative aldosterone index (aldosterone ratio in the dominant vs the non-dominant adrenal vein) revealed a high accuracy in predicting unilateral primary aldosteronism. For an immediate clinical application of our results, the adjusted cut-offs were calculated, according to the Youden's criterion and to a pre-established specificity of 90%, for all possible combinations of lesion side at imaging and presence/absence of hypokalemia. CONCLUSIONS: This study demonstrated the diagnostic accuracy of simple and clinical-/imaging-corrected aldosterone indices for adrenal vein sampling in subtype diagnosis of primary aldosteronism and suggests the potential application of these tools to select patients for adrenalectomy when standard indices cannot be performed.
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Parasiliti‐Caprino et al. (2022) conducted an observational in Primary aldosteronism (n=144). Aldosterone indices (ASI, ALI, CAI) vs. Standard cortisol indices was evaluated on Accuracy of Comparative Aldosterone Index (CAI) in predicting unilateral primary aldosteronism (AUC 0.92, 95% CI 0.87-0.96). The comparative aldosterone index (CAI) demonstrated high diagnostic accuracy in predicting unilateral primary aldosteronism with an AUC of 0.92.
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