A Practical Strategy for Primary Aldosteronism Subtyping: Leveraging the Unilateral Adrenal Vein Sampling Index When Bilateral Cannulation Fails
Authors' conclusion
Our findings establish the utility of unilateral RASI in identifying uPA and lateralizing the responsible side, especially when combined with unilateral adrenal lesions, irrespective of ACTH stimulation.
Study context
- Population
- PA patients who underwent at least unilateral selective adrenal vein sampling (AVS), regardless of adrenocorticotropic hormone (ACTH) stimulation100 unilateral primary aldosteronism (uPA), 40 non-uPA
- Participants
- 140 patients
- Comparison
- Unilateral AVS relative aldosterone secretion index (RASI) (culprit and nonculprit side), with and without ACTH stimulation, vs postoperative biochemical cure of uPA as reference standard
- Outcome
- Diagnostic accuracy of RASI (aldosterone-to-cortisol ratio between selective adrenal veins and inferior vena cava) for identifying uPA
Methodological detailsmulticenter, retrospective, 54 patients with uncertain subtype excluded
- Multicenter
- Retrospective
- 54 patients with uncertain subtype excluded
Performance
As reported in the abstract
AUC of RASI for identifying uPA (culprit / nonculprit side)
| Test or model | AUC culprit side | AUC nonculprit side | Optimal cutoff | AUC |
|---|---|---|---|---|
| Non-ACTH stimulation | 0.730 | 0.771 | >0.91 or <0.35 | |
| ACTH stimulation | 0.850 | 0.749 | >2.61 or <0.96 | |
| RASI + unilateral adrenal lesions | 0.815 to 0.873 |
AUC culprit side
Non-ACTH stimulation0.730
ACTH stimulation0.850
RASI + unilateral adrenal lesions— not stated in the abstract
AUC nonculprit side
Non-ACTH stimulation0.771
ACTH stimulation0.749
RASI + unilateral adrenal lesions— not stated in the abstract
Optimal cutoff
Non-ACTH stimulation>0.91 or <0.35
ACTH stimulation>2.61 or <0.96
RASI + unilateral adrenal lesions— not stated in the abstract
AUC
Non-ACTH stimulation— not stated in the abstract
ACTH stimulation— not stated in the abstract
RASI + unilateral adrenal lesions0.815 to 0.873
Original publication
A Practical Strategy for Primary Aldosteronism Subtyping: Leveraging the Unilateral Adrenal Vein Sampling Index When Bilateral Cannulation Fails. Endocr Pract. Published 8 April 2026. doi:10.
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