Impact of different diagnostic criteria during adrenal vein sampling on reproducibility of subtype diagnosis in patients with primary aldosteronism

Mulatero, Paolo, Bertello, Chiara, Sukor, Norlela, Gordon, Richard, Rossato, Denis, Daunt, Nicholas, Leggett, David, Mengozzi, Giulio, Veglio, Franco and Stowasser, Michael (2010) Impact of different diagnostic criteria during adrenal vein sampling on reproducibility of subtype diagnosis in patients with primary aldosteronism. Hypertension, 55 3: 667-673. doi:10.1161/HYPERTENSIONAHA.109.146613


Author Mulatero, Paolo
Bertello, Chiara
Sukor, Norlela
Gordon, Richard
Rossato, Denis
Daunt, Nicholas
Leggett, David
Mengozzi, Giulio
Veglio, Franco
Stowasser, Michael
Title Impact of different diagnostic criteria during adrenal vein sampling on reproducibility of subtype diagnosis in patients with primary aldosteronism
Journal name Hypertension   Check publisher's open access policy
ISSN 0194-911X
1524-4563
0073-425X
Publication date 2010-03
Sub-type Article (original research)
DOI 10.1161/HYPERTENSIONAHA.109.146613
Volume 55
Issue 3
Start page 667
End page 673
Total pages 7
Editor John E. Hall
Place of publication Baltimore, MD, U.S.A.
Publisher Lippincott Williams & Wilkins for the American Heart Association
Collection year 2011
Language eng
Formatted abstract
In patients with primary aldosteronism, adrenal vein sampling (AVS) is considered the only reliable technique to distinguish between unilateral and bilateral autonomous production of aldosterone, but agreement is lacking on the best criteria indicating successful cannulation and lateralization. The objective of this study was to assess the impact of differing criteria for the successful cannulation and lateralization on the reproducibility of subtype diagnosis. Sixty-two patients with confirmed primary aldosteronism underwent AVS on 2 separate occasions, because the first was unsatisfactory. We compared the different diagnoses of primary aldosteronism subtype reached using AVS data assessed by permissive (type 1), intermediate (type 2), and strict (type 3) criteria. Although 91.1% of all of the (both first and second) AVSs were "successful" by type 1 criteria (50.8% by type 2 and 33.9% by type 3), in only 35.3% of patients was the diagnosis concordant between the first and second AVS. Type 1 criteria also led to a higher rate of diagnosis of unilateral primary aldosteronism (67.3% of successful procedures) than type 2 (36.5%) or type 3 (26.2%). There was considerable disparity in the diagnosis reached using the 3 different criteria, with concordance in only 32.2%. Using either type 1 or 2 criteria, the minimal adrenal/peripheral vein cortisol ratio necessary to obtain the same diagnosis in the first and second AVS procedures was ≥2.75. In conclusion, permissive criteria for successful cannulation and lateralization on AVS achieve poor diagnostic reproducibility and should be avoided.
Copyright © 2010 American Heart Association. All rights reserved.
Keyword Endocrine hypertension
Primary aldosteronism
Aldosterone
Aldosterone-producing adenoma
Bilateral adrenal hyperplasia
Computed-tomography
Hypertension
Hyperaldosteronism
Experience
Management
Cortisol
Excess
Forms
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2011 Collection
School of Medicine Publications
 
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Created: Sun, 07 Mar 2010, 00:04:21 EST