Endocrinol Metab.  2021 Apr;36(2):401-412. 10.3803/EnM.2020.901.

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

• Lee SH
• Kim JW
• Yoon HK
• Koh JM
• Shin CS
• Kim SW
• Kim JH

• KMID: 2515466
• DOI: http://doi.org/10.3803/EnM.2020.901

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.

Keyword

Hyperaldosteronism; Hypokalemia; Aldosterone

Figure

• 

  Fig. 1 Receiver-operating characteristic (ROC) curve analyses for concordance of diagnosis between computed tomography (CT) and adrenal vein sampling findings for primary aldosteronism patients with unilateral lesion on CT. (A) Age, (B) K level, (C) plasma aldosterone concentration (PAC), and (D) tumor size. AUC, area under the ROC curve; CI, confidence interval.

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