Primary aldosteronism subtyping in the setting of partially successful adrenal vein sampling
Background and aims: Frequent failure of adrenal vein (AV) cannulation is a major obstacle to the universal use of adrenal vein sampling (AVS) for subtyping primary aldosteronism (PA). This study aimed to confirm and modify the value of a previously reported AVS parameter for PA subtyping in the cas...
| Main Authors: | , , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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SAGE Publishing
2021-02-01
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| Series: | Therapeutic Advances in Endocrinology and Metabolism |
| Online Access: | https://doi.org/10.1177/2042018821989239 |
| _version_ | 1818664958644191232 |
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| author | Seung-Eun Lee Sung Woon Park Min Sun Choi Gyuri Kim Jee Hee Yoo Jiyeon Ahn Ji Eun Jun Hong Suk Park Dongho Hyun Sung Ki Cho Seong Eun Ko Beom-Jun Kim Jong Woo Kim Hyun-Ki Yoon Jung-Min Koh Seung Hun Lee Jae Hyeon Kim |
| author_facet | Seung-Eun Lee Sung Woon Park Min Sun Choi Gyuri Kim Jee Hee Yoo Jiyeon Ahn Ji Eun Jun Hong Suk Park Dongho Hyun Sung Ki Cho Seong Eun Ko Beom-Jun Kim Jong Woo Kim Hyun-Ki Yoon Jung-Min Koh Seung Hun Lee Jae Hyeon Kim |
| author_sort | Seung-Eun Lee |
| collection | DOAJ |
| description | Background and aims: Frequent failure of adrenal vein (AV) cannulation is a major obstacle to the universal use of adrenal vein sampling (AVS) for subtyping primary aldosteronism (PA). This study aimed to confirm and modify the value of a previously reported AVS parameter for PA subtyping in the case of cannulation failure on one side. Methods: Successfully catheterized AVS studies in 157 patients (121 patients as a derivation cohort and 36 patients as a validation cohort) from two tertiary hospitals were retrospectively reviewed. The AV/inferior vena cava (IVC) index was defined by dividing the aldosterone/cortisol ratio (ACR) of AV by the ACR of the IVC. Cutoff values for lateralized PA were obtained from two methods: scatterplots and the values corresponding to Youden’s index in receiver operating characteristic (ROC) curves, on the assumption of catheterization failure on one side. Results: Due to multiple samplings in a single AVS procedure, 252 left AV/IVC ratios (LIRs) and 272 right AV/IVC ratios (RIRs) were calculated. Scatterplot cutoffs of LIR >5.4 or <0.5 predicted unilateral PA with a sensitivity of 42.1% and a specificity of 98.6%. Scatterplot cutoffs of RIR <0.5 or >7.0 showed a sensitivity of 55.1% and a specificity of 98.6%. ROC curve cutoffs of LIR ⩽0.8 or >3.1 predicted unilateral PA with a sensitivity of 82.5% and a specificity of 69.6%. ROC curve cutoffs of RIR ⩽0.8 or >3.9 resulted in 87.4% sensitivity and 80.7% specificity. Conclusion: In the case of unilateral AVS failure, the AV/IVC index may help in diagnosing PA subtype. |
| first_indexed | 2024-12-17T05:41:01Z |
| format | Article |
| id | doaj.art-771dacdfbe0e47cb8829a68bb387f902 |
| institution | Directory Open Access Journal |
| issn | 2042-0196 |
| language | English |
| last_indexed | 2024-12-17T05:41:01Z |
| publishDate | 2021-02-01 |
| publisher | SAGE Publishing |
| record_format | Article |
| series | Therapeutic Advances in Endocrinology and Metabolism |
| spelling | doaj.art-771dacdfbe0e47cb8829a68bb387f9022022-12-21T22:01:27ZengSAGE PublishingTherapeutic Advances in Endocrinology and Metabolism2042-01962021-02-011210.1177/2042018821989239Primary aldosteronism subtyping in the setting of partially successful adrenal vein samplingSeung-Eun LeeSung Woon ParkMin Sun ChoiGyuri KimJee Hee YooJiyeon AhnJi Eun JunHong Suk ParkDongho HyunSung Ki ChoSeong Eun KoBeom-Jun KimJong Woo KimHyun-Ki YoonJung-Min KohSeung Hun LeeJae Hyeon KimBackground and aims: Frequent failure of adrenal vein (AV) cannulation is a major obstacle to the universal use of adrenal vein sampling (AVS) for subtyping primary aldosteronism (PA). This study aimed to confirm and modify the value of a previously reported AVS parameter for PA subtyping in the case of cannulation failure on one side. Methods: Successfully catheterized AVS studies in 157 patients (121 patients as a derivation cohort and 36 patients as a validation cohort) from two tertiary hospitals were retrospectively reviewed. The AV/inferior vena cava (IVC) index was defined by dividing the aldosterone/cortisol ratio (ACR) of AV by the ACR of the IVC. Cutoff values for lateralized PA were obtained from two methods: scatterplots and the values corresponding to Youden’s index in receiver operating characteristic (ROC) curves, on the assumption of catheterization failure on one side. Results: Due to multiple samplings in a single AVS procedure, 252 left AV/IVC ratios (LIRs) and 272 right AV/IVC ratios (RIRs) were calculated. Scatterplot cutoffs of LIR >5.4 or <0.5 predicted unilateral PA with a sensitivity of 42.1% and a specificity of 98.6%. Scatterplot cutoffs of RIR <0.5 or >7.0 showed a sensitivity of 55.1% and a specificity of 98.6%. ROC curve cutoffs of LIR ⩽0.8 or >3.1 predicted unilateral PA with a sensitivity of 82.5% and a specificity of 69.6%. ROC curve cutoffs of RIR ⩽0.8 or >3.9 resulted in 87.4% sensitivity and 80.7% specificity. Conclusion: In the case of unilateral AVS failure, the AV/IVC index may help in diagnosing PA subtype.https://doi.org/10.1177/2042018821989239 |
| spellingShingle | Seung-Eun Lee Sung Woon Park Min Sun Choi Gyuri Kim Jee Hee Yoo Jiyeon Ahn Ji Eun Jun Hong Suk Park Dongho Hyun Sung Ki Cho Seong Eun Ko Beom-Jun Kim Jong Woo Kim Hyun-Ki Yoon Jung-Min Koh Seung Hun Lee Jae Hyeon Kim Primary aldosteronism subtyping in the setting of partially successful adrenal vein sampling Therapeutic Advances in Endocrinology and Metabolism |
| title | Primary aldosteronism subtyping in the setting of partially successful adrenal vein sampling |
| title_full | Primary aldosteronism subtyping in the setting of partially successful adrenal vein sampling |
| title_fullStr | Primary aldosteronism subtyping in the setting of partially successful adrenal vein sampling |
| title_full_unstemmed | Primary aldosteronism subtyping in the setting of partially successful adrenal vein sampling |
| title_short | Primary aldosteronism subtyping in the setting of partially successful adrenal vein sampling |
| title_sort | primary aldosteronism subtyping in the setting of partially successful adrenal vein sampling |
| url | https://doi.org/10.1177/2042018821989239 |
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