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Subtype prediction of primary aldosteronism by combining aldosterone concentrations in the left adrenal vein and inferior vena cava: a multicenter collaborative study on adrenal venous sampling

Journal of Human Hypertension volume 32, pages 12–19 (2018)Cite this article

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Abstract

Subtype diagnosis of primary aldosteronism (PA) by adrenal vein sampling (AVS) is recommended as a mandatory step for indicating adrenal surgery. It is a technically demanding procedure, especially in the right adrenal vein. The aim of the study was to predict the subtype diagnosis in the absence of values from the right AVS. From the databases of nine centers (WAVES-J), 308 patients with PA who underwent successful AVS were studied. Based on the ipsilateral ratio (IR) (aldosterone/cortisol ratio of the left adrenal vein [A/Cleft AV] / aldosterone/cortisol ratio of the inferior vena cava [A/CIVC]), the patients were divided into two groups: the patients with IR ≥ 1.0 (n = 262) and those with IR < 1.0 (n = 46). In patients with IR > 1.0, the A/Cleft AV was significantly higher in patients with the left unilateral subtype than in patients with the bilateral subtype. Receiver operating characteristic (ROC) curve analysis revealed that an A/Cleft AV cutoff >68 showed 70.8% sensitivity and 93.5% specificity for the left unilateral subtype. On the other hand, in patients with IR < 1.0, the A/Cleft AV was significantly lower in patients with the right unilateral subtype. ROC analysis revealed that an A/Cleft AV cutoff <9 showed 86.7% sensitivity and 75.0% specificity for the right unilateral subtype. Hence, the combination of the IR and A/C ratio in the left adrenal vein is useful for predicting the subtype. The present results provide important information for patients with PA in whom AVS was unsuccessful in the right adrenal vein.

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Acknowledgements

This study was supported, in part, by grants-in-aid for the study of primary aldosteronism in Japan (JPAS) from The Practical Research Project for Rare/Intractable Disease from the Japan Agency for Medical Research and Development (AMED) (15Aek0509122) and a Grant from the National Center for Global Health and Medicine, Japan (24-1402).

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Authors and Affiliations

  1. Department of Cardiology, JR Hiroshima Hospital, Hiroshima, Japan

    Yuichi Fujii

  2. Department of Endocrinology, Metabolism, and Hypertension, National Hospital Organization Kyoto Medical Center, Kyoto, Japan

    Hironobu Umakoshi, Kazutaka Nanba, Mika Tsuiki & Mitsuhide Naruse

  3. Department of Diabetes and Endocrinology, Sapporo City Hospital, Sapporo, Japan

    Norio Wada

  4. Department of Diabetes and Endocrinology, Saiseikai Yokohama City Toubu Hospital, Yokohama, Japan

    Takamasa Ichijo

  5. Department of Cardiology, Akashi Medical Center, Akashi, Japan

    Kohei Kamemura

  6. Department of Cardiology, Sanda City Hospital, Sanda, Japan

    Yuichi Matsuda

  7. Department of Cardiology, Saiseikai Tondabayashi Hospital, Osaka, Japan

    Tatsuya Kai

  8. Department of Internal Medicine, Matsuyama Red Cross Hospital, Matsuyama, Japan

    Tomikazu Fukuoka

  9. Department of Endocrinology and Metabolism, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan

    Ryuichi Sakamoto & Atsushi Ogo

  10. Department of Public Health,School of Medicine, International University of Health and Welfare, Narita, Japan

    Tomoko Suzuki

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on behalf of WAVES-J Study Group

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Correspondence to Yuichi Fujii.

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Fujii, Y., Umakoshi, H., Wada, N. et al. Subtype prediction of primary aldosteronism by combining aldosterone concentrations in the left adrenal vein and inferior vena cava: a multicenter collaborative study on adrenal venous sampling. J Hum Hypertens 32, 12–19 (2018). https://doi.org/10.1038/s41371-017-0015-0

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