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A subtype prediction score for primary aldosteronism

Abstract

Primary aldosteronism (PA) is the most common cause of endocrine hypertension. Although adrenal venous sampling (AVS) is recommended as the gold standard procedure for subtype classification in PA, it is a specialized technique with limited availability. The objective of this study was to develop a scoring system that predicted PA subtype using clinical characteristics. Seventy-one patients with PA were studied. The subjects were diagnosed as having either unilateral (n=32) or bilateral disease (n=39) based on AVS, surgery and/or the postoperative clinical course. Variables associated with laterality in the univariate analysis were entered into multivariable logistic regression models and the regression coefficients were used to construct a subtype prediction score. The diagnostic significance of the score was then evaluated using receiver operating characteristic (ROC) curve analysis. The subtype prediction score was calculated as follows: serum potassium 3.4 mEq l–1, 2 points; plasma aldosterone concentration 165 pg ml–1, 3 points; and aldosterone to renin ratio 1000 in a post-captopril challenge test (plasma renin activity in ng ml–1 h–1), 3 points. ROC curve analysis for the ability to discriminate between unilateral and bilateral PA showed that a score of 5 points had 75% sensitivity and 95% specificity, and a score of 3 points had a sensitivity of 97% and a specificity of 59%. The area under the ROC curve was 0.920 (95% confidence interval, 0.859–0.979). Our subtype prediction score could discriminate between unilateral and bilateral PA and is useful for selecting patients who should undergo AVS before surgery.

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References

  1. Gordon RD, Stowasser M, Tunny TJ, Klemm SA, Rutherford JC . High incidence of primary aldosteronism in 199 patients referred with hypertension. Clin Exp Pharmacol Physiol 1994; 21 (4): 315–318.

    Article  CAS  Google Scholar 

  2. Williams JS, Williams GH, Raji A, Jeunemaitre X, Brown NJ, Hopkins PN et al. Prevalence of primary hyperaldosteronism in mild to moderate hypertension without hypokalaemia. J Hum Hypertens 2006; 20 (2): 129–136.

    Article  CAS  Google Scholar 

  3. Calhoun DA . Hyperaldosteronism among black and white subjects with resistant hypertension. Hypertension 2002; 40 (6): 892–896.

    Article  CAS  Google Scholar 

  4. Funder JW, Carey RM, Fardella C, Gomez-Sanchez CE, Mantero F, Stowasser M et al. Case detection, diagnosis, and treatment of patients with primary aldosteronism: an endocrine society clinical practice guideline. J Clin Endocrinol Metab 2008; 93 (9): 3266–3281.

    Article  CAS  Google Scholar 

  5. Young WF . Primary aldosteronism: renaissance of a syndrome. Clin Endocrinol (Oxf) 2007; 66 (5): 607–618.

    Article  CAS  Google Scholar 

  6. Nanba K, Tamanaha T, Nakao K, Kawashima ST, Usui T, Tagami T et al. Confirmatory testing in primary aldosteronism. J Clin Endocrinol Metab 2012; 97 (5): 1688–1694.

    Article  CAS  Google Scholar 

  7. Ogihara T, Kikuchi K, Matsuoka H, Fujita T, Higaki J, Horiuchi M et al. The Japanese Society of Hypertension Guidelines for the Management of Hypertension (JSH 2009). Hypertens Res 2009; 32 (1): 3–107.

    CAS  Google Scholar 

  8. Nishikawa T, Omura M, Satoh F, Shibata H, Takahashi K, Tamura N et al. Guidelines for the diagnosis and treatment of primary aldosteronism -the Japan Endocrine Society 2009. Endocr J 2011; 58: 711–721.

    Article  CAS  Google Scholar 

  9. Sukor N, Gordon RD, Ku YK, Jones M, Stowasser M . Role of unilateral adrenalectomy in bilateral primary aldosteronism: a 22-year single center experience. J Clin Endocrinol Metab 2009; 94 (7): 2437–2445.

    Article  CAS  Google Scholar 

  10. Nishikawa T, Omura M . Clinical characteristics of primary aldosteronism: its prevalence and comparative studies on various causes of primary aldosteronism in Yokohama Rosai Hospital. Biomed Pharmacother 2000; 54 (Suppl 1): 83s–85s.

    Article  Google Scholar 

  11. Ito Y, Takeda R, Karashima S, Yamamoto Y, Yoneda T, Takeda Y . Prevalence of primary aldosteronism among prehypertensive and stage 1 hypertensive subjects. Hypertens Res 2011; 34 (1): 98–102.

    Article  CAS  Google Scholar 

  12. Rossi GP, Barisa M, Allolio B, Auchus RJ, Amar L, Cohen D et al. The Adrenal Vein Sampling International Study (AVIS) for identifying the major subtypes of primary aldosteronism. J Clin Endocrinol Metab 2012; 97 (5): 1606–1614.

    Article  CAS  Google Scholar 

  13. Strauch B, Zelinka T, Hampf M, Bernhardt R, Widimsky J Jr . Prevalence of primary hyperaldosteronism in moderate to severe hypertension in the Central Europe region. J Hum Hypertens 2003; 17 (5): 349–352.

    Article  CAS  Google Scholar 

  14. Westerdahl C, Bergenfelz A, Isaksson A, Nerbrand C, Valdemarsson S . Primary aldosteronism among newly diagnosed and untreated hypertensive patients in a Swedish primary care area. Scand J Prim Health Care 2011; 29 (1): 57–62.

    PubMed  PubMed Central  Google Scholar 

  15. Rossi GP, Bernini G, Caliumi C, Desideri G, Fabris B, Ferri C et al. A prospective study of the prevalence of primary aldosteronism in 1,125 hypertensive patients. J Am Coll Cardiol 2006; 48 (11): 2293–2300.

    Article  CAS  Google Scholar 

  16. Nomura K, Kusakabe K, Maki M, Ito Y, Aiba M, Demura H . Iodomethylnorcholesterol uptake in an aldosteronoma shown by dexamethasone-suppression scintigraphy: relationship to adenoma size and functional activity. J Clin Endocrinol Metab 1990; 71 (4): 825–830.

    Article  CAS  Google Scholar 

  17. Burton TJ, Mackenzie IS, Balan K, Koo B, Bird N, Soloviev DV et al. Evaluation of the sensitivity and specificity of (11)C-metomidate positron emission tomography (PET)-CT for lateralizing aldosterone secretion by Conn's adenomas. J Clin Endocrinol Metab 2012; 97 (1): 100–109.

    Article  CAS  Google Scholar 

  18. Kupers EM, Amar L, Raynaud A, Plouin PF, Steichen O . A clinical prediction score to diagnose unilateral primary aldosteronism. J Clin Endocrinol Metab 2012; 97 (10): 3530–3537.

    Article  CAS  Google Scholar 

  19. Rossi GP, Bernini G, Desideri G, Fabris B, Ferri C, Giacchetti G et al. Renal damage in primary aldosteronism: results of the PAPY Study. Hypertension 2006; 48 (2): 232–238.

    Article  CAS  Google Scholar 

  20. Sonoyama T, Sone M, Miyashita K, Tamura N, Yamahara K, Park K et al. Significance of adrenocorticotropin stimulation test in the diagnosis of an aldosterone-producing adenoma. J Clin Endocrinol Metab 2011; 96 (9): 2771–2778.

    Article  CAS  Google Scholar 

  21. Biglieri EG, Irony I, Kater CE . Identification and implications of new types of mineralocorticoid hypertension. J Steroid Biochem 1989; 32 (1B): 199–204.

    Article  CAS  Google Scholar 

  22. Rossi GP, Seccia TM, Pessina AC . Primary aldosteronism: part II: subtype differentiation and treatment. J Nephrol 2008; 21 (4): 455–462.

    CAS  PubMed  Google Scholar 

  23. Nishimoto K, Nakagawa K, Li D, Kosaka T, Oya M, Mikami S et al. Adrenocortical zonation in humans under normal and pathological conditions. J Clin Endocrinol Metab 2010; 95 (5): 2296–2305.

    Article  CAS  Google Scholar 

  24. Nanba K, Tsuiki M, Sawai K, Mukai K, Nishimoto K, Usui T et al. histopathological diagnosis of primary aldosteronism using CYP11B2 immunohistochemistry. J Clin Endocrinol Metab 2013; 98 (4): 1567–1574.

    Article  CAS  Google Scholar 

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Acknowledgements

This study was supported, in part, by grants-in-aid for the study of PA from the National Hospital Organization, and for the study of Adrenal Hormone Disorders from the Ministry of Health, Labor and Welfare, Japan.

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Correspondence to M Naruse.

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The authors declare no conflict of interest.

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Supplementary Information accompanies this paper on the Journal of Human Hypertension website

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Nanba, K., Tsuiki, M., Nakao, K. et al. A subtype prediction score for primary aldosteronism. J Hum Hypertens 28, 716–720 (2014). https://doi.org/10.1038/jhh.2014.20

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