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CT accurate for diagnosis of primary aldosteronism subtype in younger patients

Issue: May 2016

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BOSTON — At least some patients with primary aldosteronism can avoid adrenal venous sampling for determining the laterality of aldosterone excess, according to study data presented here.

CT diagnosis was confirmed by adrenal venous sampling (AVS) in patients aged 35 years or younger with solitary unilateral apparent adenoma; however, diagnostic accuracy of CT was lower in patients aged 36 to 40 years.

Tatsuki Ogasawara

In a retrospective multicenter collaborative study, Tatsuki Ogasawara, MD, of the National Hospital Organization Kyoto Medical Center in Japan, and colleagues evaluated data from the WAVES-J database for 2006 to 2013 on 61 patients with primary aldosteronism for whom AVS and CT data were available; 30 were aged 35 years or younger, and 31 were aged 36 to 40 years.

CT and AVS concordance was higher in the younger patients compared with those older than 35 years (OR = 10.1; 95% CI 1.0-523.2). Diagnosis of subtype by CT and AVS agreed in 87% of younger patients; concordance rate was 94% in patients with a unilateral adrenal nodule and 100% in those with a nodule and spontaneous hypokalemia. Unilateral adrenalectomy was performed in 14 of the younger patients, and in the 11 with post-operative data available, cure was confirmed by surgical outcome. CT and AVS subtype diagnosis agreed in only 68% of the older patient group — 56% of patients with a unilateral adrenal nodule and 87.5% of patients with a nodule and spontaneous hypokalemia.

“In those less than 35 years old, when a CT-obvious adrenal nodule exists, we may skip AVS because CT is very accurate,” Ogasawara told Endocrine Today. “But this is only a small study. If we can demonstrate [in a larger study] that CT is good in patients less than 35 years old, maybe we can do adrenalectomy without AVS.” – by Jill Rollet

Reference:

Ogasawara T, et al. Poster LBFri-22. Presented at: The Endocrine Society Annual Meeting; April 1-4, 2016; Boston.

Disclosure: Ogasawara reports no relevant financial disclosures.