Impact of different diagnostic criteria during adrenal vein sampling on reproducibility of subtype diagnosis in patients with primary aldosteronism

Paolo Mulatero, Chiara Bertello, Norlela Sukor, Richard Gordon, Denis Rossato, Nicholas Daunt, David Leggett, Giulio Mengozzi, Franco Veglio, Michael Stowasser

Research output: Contribution to journalArticle

96 Citations (Scopus)

Abstract

In patients with primary aldosteronism, adrenal vein sampling (AVS) is considered the only reliable technique to distinguish between unilateral and bilateral autonomous production of aldosterone, but agreement is lacking on the best criteria indicating successful cannulation and lateralization. The objective of this study was to assess the impact of differing criteria for the successful cannulation and lateralization on the reproducibility of subtype diagnosis. Sixty-two patients with confirmed primary aldosteronism underwent AVS on 2 separate occasions, because the first was unsatisfactory. We compared the different diagnoses of primary aldosteronism subtype reached using AVS data assessed by permissive (type 1), intermediate (type 2), and strict (type 3) criteria. Although 91.1% of all of the (both first and second) AVSs were "successful" by type 1 criteria (50.8% by type 2 and 33.9% by type 3), in only 35.3% of patients was the diagnosis concordant between the first and second AVS. Type 1 criteria also led to a higher rate of diagnosis of unilateral primary aldosteronism (67.3% of successful procedures) than type 2 (36.5%) or type 3 (26.2%). There was considerable disparity in the diagnosis reached using the 3 different criteria, with concordance in only 32.2%. Using either type 1 or 2 criteria, the minimal adrenal/peripheral vein cortisol ratio necessary to obtain the same diagnosis in the first and second AVS procedures was ≥2.75. In conclusion, permissive criteria for successful cannulation and lateralization on AVS achieve poor diagnostic reproducibility and should be avoided.

Original languageEnglish
Pages (from-to)667-673
Number of pages7
JournalHypertension
Volume55
Issue number3
DOIs
Publication statusPublished - Mar 2010
Externally publishedYes

Fingerprint

Hyperaldosteronism
Veins
Catheterization
Aldosterone
Hydrocortisone

Keywords

  • Aldosterone
  • Aldosterone-producing adenoma
  • Bilateral adrenal hyperplasia
  • Endocrine hypertension
  • Primary aldosteronism

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Impact of different diagnostic criteria during adrenal vein sampling on reproducibility of subtype diagnosis in patients with primary aldosteronism. / Mulatero, Paolo; Bertello, Chiara; Sukor, Norlela; Gordon, Richard; Rossato, Denis; Daunt, Nicholas; Leggett, David; Mengozzi, Giulio; Veglio, Franco; Stowasser, Michael.

In: Hypertension, Vol. 55, No. 3, 03.2010, p. 667-673.

Research output: Contribution to journalArticle

Mulatero, P, Bertello, C, Sukor, N, Gordon, R, Rossato, D, Daunt, N, Leggett, D, Mengozzi, G, Veglio, F & Stowasser, M 2010, 'Impact of different diagnostic criteria during adrenal vein sampling on reproducibility of subtype diagnosis in patients with primary aldosteronism', Hypertension, vol. 55, no. 3, pp. 667-673. https://doi.org/10.1161/HYPERTENSIONAHA.109.146613
Mulatero, Paolo ; Bertello, Chiara ; Sukor, Norlela ; Gordon, Richard ; Rossato, Denis ; Daunt, Nicholas ; Leggett, David ; Mengozzi, Giulio ; Veglio, Franco ; Stowasser, Michael. / Impact of different diagnostic criteria during adrenal vein sampling on reproducibility of subtype diagnosis in patients with primary aldosteronism. In: Hypertension. 2010 ; Vol. 55, No. 3. pp. 667-673.
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AU - Daunt, Nicholas

AU - Leggett, David

AU - Mengozzi, Giulio

AU - Veglio, Franco

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