Age below 40 or a recently proposed clinical prediction score cannot bypass adrenal venous sampling in primary aldosteronism

Abstract

Context: Adrenal venous sampling (AVS) is used to distinguish bilateral from unilateral primary aldosteronism (PA). Due to its limited availability, clinical prediction scores have been proposed to diagnose unilateral disease without AVS. Objective: Our goal was to test 2 recently proposed predictors of unilateral PA: 1) a clinical prediction score using imaging, serum potassium, and glomerular filtration rate and 2) the combination of visible unilateral adenoma on imaging and age 40 years. Design and Setting: We used the data of all patients with PA of the prospective German Conn's Registry treated in Munich and Berlin since 2008. Patients and Intervention: Of 205 patients with PA, 194 had a successful AVS and were included. Main Outcome Measures: Parameters were compared between patients with lateralized and nonlateralized AVS. Specificity and sensitivity of the proposed predictors were calculated. Results: A total of 130 patients (67%) had unilateral PA according to AVS. Patients with unilateral PA showed a significantly lower estimated glomerular filtration rate compared with patients with bilateral disease (P