SpringerLink
Log in

Significance of adrenal computed tomography in predicting laterality and indicating adrenal vein sampling in primary aldosteronism

  • Original Article
  • Published:
Journal of Human Hypertension Submit manuscript

Abstract

Although laterality assessed by computed tomography (CT) in primary aldosteronism (PA) is not always concordant with that assessed by adrenal vein sampling (AVS), it is unclear whether all patients diagnosed with PA should undergo AVS for subtype classification. The aim of the current study was to investigate the accuracy of CT in subtype classification and to develop a prediction score for bilateral subtype in patients without adrenal tumour. As part of the WAVES-J study, 393 patients with PA were analysed. Subty** using CT was concordant with that using AVS in 68% (269/393) of patients in the total sample, and in 38% (68/156) of patients with unilateral tumours, 56% (5/9) of patients with bilateral tumours and 89% (204/228) of patients without tumour. In patients without tumour, female gender, plasma aldosterone concentration (pg ml−1) to plasma renin activity ratio ⩽550 and serum potassium ⩾3.8 mEq l−1 were shown to be independent predictors for bilateral subtype. A prediction score based on these three variables was constructed with one point attributed to each variable. A score of three points had 29% sensitivity and 96% specificity in a receiver operating characteristic curve analysis. The results suggest that although CT is not sufficiently accurate for subtype classification in patients with adrenal tumours, it is sufficient to determine bilateral subtype in patients without tumour. Moreover, using our clinical prediction score in patients without tumour could be useful in determining the necessity of AVS for subtype classification.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price includes VAT (United Kingdom)

Instant access to the full article PDF.

Institutional subscriptions

Figure 1
Figure 2

Similar content being viewed by others

References

  1. 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: 2293–2300.

    Article  CAS  PubMed  Google Scholar 

  2. Kempers MJE, Lenders JWM, Van Outheusden L, Van Der Wilt GJ, Schultze Kool LJ, Hermus AR et al. Systematic review : diagnostic procedures to differentiate unilateral from bilateral adrenal abnormality in primary aldosteronism. Ann Intern Med 2009; 151: 329–338.

    Article  PubMed  Google Scholar 

  3. Mulatero P, Dluhy RG, Giacchetti G, Boscaro M, Veglio F, Stewart PM . Diagnosis of primary aldosteronism: from screening to subtype differentiation. Trends Endocrinol Metab 2005; 16: 114–119.

    Article  CAS  PubMed  Google Scholar 

  4. Rossi GP, Dalla Cà A . Clinical management of primary aldosteronism. 2013 practical recommendations of the Italian Society of Hypertension (SIIA). High Blood Press Cardiovasc Prev 2014; 21: 71–75.

    Article  CAS  PubMed  Google Scholar 

  5. Rossi GP, Pessina AC, Heagerty AM . Primary aldosteronism: an update on screening, diagnosis and treatment. J Hypertens 2008; 26: 613–621.

    Article  CAS  PubMed  Google Scholar 

  6. Stowasser M . Update in primary aldosteronism. J Clin Endocrinol Metab 2009; 94: 3623–3630.

    Article  CAS  PubMed  Google Scholar 

  7. Vonend O, Ockenfels N, Gao X, Allolio B, Lang K, Mai K et al. Adrenal venous sampling: evaluation of the German conn’s registry. Hypertension 2011; 57: 990–995.

    Article  CAS  PubMed  Google Scholar 

  8. Magill SB, Raff H, Shaker JL, Brickner RC, Knechtges TE, Kehoe ME et al. Comparison of adrenal vein sampling and computed tomography in the differentiation of primary aldosteronism. J Clin Endocrinol Metab 2001; 86: 1066–1071.

    CAS  PubMed  Google Scholar 

  9. Nwariaku FE, Miller BS, Auchus R, Holt S, Watumull L, Dolmatch B et al. Primary hyperaldosteronism: effect of adrenal vein sampling on surgical outcome. Arch Surg 2006; 141: 497–502 discussion 502–3.

    Article  PubMed  Google Scholar 

  10. Sarlon-Bartoli G, Michel N, Taieb D, Mancini J, Gonthier C, Silhol F et al. Adrenal venous sampling is crucial before an adrenalectomy whatever the adrenal-nodule size on computed tomography. J Hypertens 2011; 29: 1196–1202.

    Article  CAS  PubMed  Google Scholar 

  11. Young WF, Stanson AW, Thompson GB, Grant CS, Farley DR, van Heerden JA . Role for adrenal venous sampling in primary aldosteronism. Surgery 2004; 136: 1227–1235.

    Article  PubMed  Google Scholar 

  12. Rossi GP, Pitter G, Bernante P, Motta R, Feltrin G, Miotto D . Adrenal vein sampling for primary aldosteronism: the assessment of selectivity and lateralization of aldosterone excess baseline and after adrenocorticotropic hormone (ACTH) stimulation. J Hypertens 2008; 26: 989–997.

    Article  CAS  PubMed  Google Scholar 

  13. Rossi GP, Auchus RJ, Brown M, Lenders JWM, Naruse M, Plouin PF et al. An expert consensus statement on use of adrenal vein sampling for the subty** of primary aldosteronism. Hypertension 2014; 63: 151–160.

    Article  CAS  PubMed  Google Scholar 

  14. Shimamoto K, Ando K, Fujita T, Hasebe N, Higaki J, Horiuchi M et al. The Japanese Society of Hypertension Guidelines for the Management of Hypertension (JSH 2014). Hypertens Res 2014; 37: 253–390.

    Article  PubMed  Google Scholar 

  15. 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: 1606–1614.

    Article  CAS  PubMed  Google Scholar 

  16. Daunt N . Adrenal vein sampling: how to make it quick, easy, and successful. Radiographics 2005; 25 (Suppl 1): S143–S158.

    Article  PubMed  Google Scholar 

  17. 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  PubMed  Google Scholar 

  18. Zarnegar R, Bloom AI, Lee J, Kerlan RK, Wilson MW, Laberge JM et al. Is adrenal venous sampling necessary in all patients with hyperaldosteronism before adrenalectomy? J Vasc Interv Radiol 2008; 19: 66–71.

    Article  PubMed  Google Scholar 

  19. Umakoshi H, Wada N, Ichijo T, Kamemura K, Matsuda Y, Fuji Y et al. Optimum position of left adrenal vein sampling for subtype diagnosis in primary aldosteronism. Clin Endocrinol (Oxf) 2015; 83: 768–773.

    Article  CAS  Google Scholar 

  20. Lim V, Guo Q, Grant CS, Thompson GB, Richards ML, Farley DR et al. Accuracy of adrenal imaging and adrenal venous sampling in predicting surgical cure of primary aldosteronism. J Clin Endocrinol Metab 2014; 99: 2712–2719.

    Article  CAS  PubMed  Google Scholar 

  21. Satoh F, Abe T, Tanemoto M, Nakamura M, Abe M, Uruno A et al. Localization of aldosterone-producing adrenocortical adenomas: significance of adrenal venous sampling. Hypertens Res 2007; 30: 1083–1095.

    Article  CAS  PubMed  Google Scholar 

  22. Omura M, Sasano H, Saito J, Yamaguchi K, Kakuta Y, Nishikawa T . Clinical characteristics of aldosterone-producing microadenoma, macroadenoma, and idiopathic hyperaldosteronism in 93 patients with primary aldosteronism. Hypertens Res 2006; 29: 883–889.

    Article  CAS  PubMed  Google Scholar 

  23. Stowasser M, Gordon RD . Primary aldosteronism - careful investigation is essential and rewarding. Mol Cell Endocrinol 2004; 217: 33–39.

    Article  CAS  PubMed  Google Scholar 

  24. Küpers EM, Amar L, Raynaud A, Plouin P-F, Steichen O . A clinical prediction score to diagnose unilateral primary aldosteronism. J Clin Endocrinol Metab 2012; 97: 3530–3537.

    Article  PubMed  Google Scholar 

  25. Nanba K, Tsuiki M, Nakao K, Nanba A, Usui T, Tagami T et al. A subtype prediction score for primary aldosteronism. J Hum Hypertens 2014; 28: 716–720.

    Article  CAS  PubMed  Google Scholar 

  26. Minami I, Yoshimoto T, Hirono Y, Izumiyama H, Doi M, Hirata Y . Diagnostic accuracy of adrenal venous sampling in comparison with other parameters in primary aldosteronism. Endocr J 2008; 55: 839–846.

    Article  PubMed  Google Scholar 

  27. Williams TA, Monticone S, Schack VR, Stindl J, Burrello J, Buffolo F et al. Somatic ATP1A1, ATP2B3, and KCNJ5 mutations in aldosterone-producing adenomas. Hypertension 2014; 63: 188–195.

    Article  CAS  PubMed  Google Scholar 

  28. Obara T, Ito Y, Okamoto T, Kanaji Y, Yamashita T, Aiba M et al. Risk factors associated with postoperative persistent hypertension in patients with primary aldosteronism. Surgery 1992; 112: 987–993.

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Cardiology,

    K Kamemura

  2. Akashi Medical Center, Akashi, Japan

    K Kamemura

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

    N Wada

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

    T Ichijo

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

    Y Matsuda

  6. Department of Cardiology, Hiroshima General Hospital of West Japan Railway Company, Hiroshima, Japan

    Y Fujii

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

    T Kai

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

    T Fukuoka

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

    R Sakamoto & A Ogo

  10. Department of Public Health, Kitasato University School of Medicine, Tokyo, Japan

    T Suzuki

  11. Department of Endocrinology, Metabolism, and Hypertension, Clinical Research Institute, National Hospital Organization Kyoto Medical Center, Kyoto, Japan

    H Umakoshi, M Tsuiki & M Naruse

Authors
  1. K Kamemura
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. N Wada
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. T Ichijo
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Y Matsuda
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Y Fujii
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. T Kai
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. T Fukuoka
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. R Sakamoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. A Ogo
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. T Suzuki
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. H Umakoshi
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. M Tsuiki
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. M Naruse
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to K Kamemura.

Ethics declarations

Competing interests

The authors declare no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kamemura, K., Wada, N., Ichijo, T. et al. Significance of adrenal computed tomography in predicting laterality and indicating adrenal vein sampling in primary aldosteronism. J Hum Hypertens 31, 195–199 (2017). https://doi.org/10.1038/jhh.2016.61

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/jhh.2016.61

  • Springer Nature Limited

Search

Navigation