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Diagnostic Accuracy of Computed Tomography in Predicting Primary Aldosteronism Subtype According to Age

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Abstract
Background: Guidelines by the Endocrine Society Guideline on bypassing adrenal vein sampling (AVS) in patients < 35 years old with marked primary aldosteronism (PA) (hypokalemia and elevated plasma aldosterone concentration [PAC]) and a unilateral lesion on computed tomography (CT) are based on limited number of studies. We aimed to determine the accuracy of CT in PA patients according to age.

Methods: In this retrospective study, we investigated the concordance between CT and AVS in 466 PA patients from two tertiary centers who successfully underwent AVS.

Results: CT had an overall accuracy of 64.4% (300/466). In the group with unilateral lesion, patients with hypokalemia had higher concordance than those without hypokalemia (85.0% vs. 43.6%, P< 0.001). In the group with marked PA (hypokalemia and PAC > 15.9 ng/dL) and unilateral lesion, accuracy of CT was 84.6% (11/13) in patients aged <35 years; 100.0% (20/20), aged 35 to 39 years; 89.4% (59/66), aged 40 to 49 years; and 79.8% (79/99), aged >= 50 years. Cut-off age and PAC for concordance was < 50 years and > 29.6 ng/dL, respectively. The significant difference in accuracy of CT in 198 patients with marked PA and a unilateral lesion between the < 50-year age group and =50-year age group (90.9% vs. 79.8%, P= 0.044) disappeared in 139 of 198 patients with PAC > 30.0 ng/dL (91.9% vs. 87.7%, P=0.590).

Conclusion: Patients with hypokalemia, PAC > 30.0 ng/dL, and unilateral lesion were at high risk of unilateral PA regardless of age.
Author(s)
고정민김상완김정희김종우신찬수윤현기이승훈
Issued Date
2021
Type
Article
Keyword
내과학
DOI
10.3803/EnM.2021.402
URI
https://oak.ulsan.ac.kr/handle/2021.oak/7880
https://ulsan-primo.hosted.exlibrisgroup.com/primo-explore/fulldisplay?docid=TN_cdi_nrf_kci_oai_kci_go_kr_ARTI_9852952&amp;context=PC&amp;vid=ULSAN&amp;lang=ko_KR&amp;search_scope=default_scope&amp;adaptor=primo_central_multiple_fe&amp;tab=default_tab&amp;query=any,contains,Diagnostic%20Accuracy%20of%20Computed%20Tomography%20in%20Predicting%20Primary%20Aldosteronism%20Subtype%20According%20to%20Age&amp;offset=0&amp;pcAvailability=true
Publisher
ENDOCRINOLOGY AND METABOLISM
Location
대한민국
Language
영어
ISSN
2093-596X
Citation Volume
36
Citation Number
2
Citation Start Page
401
Citation End Page
412
Appears in Collections:
Medicine > Medicine
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