Assessing Lateralization Index of Adrenal Venous Sampling for Surgical Indication in Primary Aldosteronism
Authors' conclusion
The present study clarified the optimal LI cutoffs for without and with ACTH stimulation. The presence of contralateral suppression and adrenal nodule on CT imaging seems to provide additional available information besides LI for surgical indication.
Study context
- Population
- Patients with primary aldosteronism (PA) who underwent adrenal venous sampling (AVS), with and/or without ACTH stimulation, 16 institutions in 11 countries; cutoffs informed by a survey of 82 patients with PA in Japan
- Participants
- 1,550 patients16 institutions
- Exposure
- Unstimulated vs ACTH-stimulated AVS lateralization index cutoffs
- Outcome
- Optimal LI cutoffs in AVS for diagnosing surgically curable PA (adjusted PPV of 80%)
Methodological detailsinternational, multicentre
- International
- Multicentre
Main finding
As reported in the abstract
Optimal LI cutoff achieving adjusted PPV of 80%
Unstimulated AVS
3.8
ACTH-stimulated AVS
3.4
Observational data: associations, not effects.
Further findings
Adjusted PPV with optimal LI cutoffs plus contralateral ratio and CT nodule
Patient survey: median cure rate expectation motivating adrenalectomy
- Median cure rate expectation
- 80%
- Survey of 82 patients with PA in Japan
Independent predictors of surgically curable PA
- Contralateral ratio <0.4 and adrenal nodule on CT were independent predictors
Original publication
Assessing Lateralization Index of Adrenal Venous Sampling for Surgical Indication in Primary Aldosteronism. J Clin Endocrinol Metab. Published 15 May 2024. doi:10.
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