CONTEXT: Adrenal gland imaging is recommended by the current guidelines for the workup of primary aldosteronism (PA). However, its diagnostic performance has not been established in large, multiethnic cohorts of patients who undergo adrenal vein sampling (AVS) and adrenalectomy. OBJECTIVE: This work aims to assess the diagnostic accuracy of cross-sectional adrenal imaging. METHODS: This international multicenter study took place in tertiary referral centers. A total of 1625 PA patients seeking surgical cure were enrolled in an international study involving 19 centers in North America, Europe, Asia, and Australia. Of these, 1311 (81%) had imaging data available and 369 (23%), who received a final diagnosis of surgically cured unilateral PA, were examined. Patients underwent AVS and imaging by computed tomography and/or magnetic resonance imaging. The accuracy of detection of unilateral PA at imaging was estimated by the area under the receiver operator characteristics curve using cure (biochemical and/or full clinical success) as the reference at follow-up after unilateral adrenalectomy. RESULTS: In the cohort of 1311 patients with imaging data available, 34% and 7% of cases showed no detectable or bilateral nodules, respectively. Imaging did not detect the culprit adrenal in 28% of the surgically cured unilateral PA patients. Moreover, the clinical outcome did not differ significantly between the imaging-positive and imaging-negative patients. CONCLUSION: Cross-sectional imaging did not identify a lateralized cause of disease in around 40% of PA patients and failed to identify the culprit adrenal in more than one-fourth of patients with unilateral PA.

3rd Department of Medicine Charles University General Faculty Hospital Prague Czech Republic

AP HP Hôpital Européen Georges Pompidou Hypertension Department and DMU CARTE Paris France

Centre for Endocrinology and Metabolism Hudson Institute of Medical Research Clayton Victoria Australia

Department of Diabetes Endocrinology and Metabolism National Center for Global Health and Medicine Tokyo Japan

Department of Endocrinology Clinical Research Institute NHO Kyoto Medical Center and Endocrine Center Ijinkai Takeda General Hospital Kyoto Japan

Department of Endocrinology Diabetes and Metabolic Diseases University Medical Center Ljubljana Ljubljana Slovenia

Department of Endocrinology North Western Medical University named after 1 1 Mechnikov Saint Petersburg Russia

Department of Internal Medicine Azienda Unità Sanitaria Locale IRCCS Arcispedale S Maria Nuova Hypertension Unit Reggio Emilia Italy

Department of Internal Medicine National Taiwan University Hospital Taipei Taiwan

Department of Internal Medicine Radboud University Medical Center HB Nijmegen the Netherlands

Department of Medicine Monash University Clayton 3168 Victoria Australia

Department of Nephrology Hypertension Unit Hospital del Mar; Universitat Pompeu Fabra; IMIM Barcelona Spain

Department of Radiology Radboud University Medical Center HB Nijmegen the Netherlands

Division of Endocrinology and Metabolism Rostock University Medical Center Rostock Germany

Division of Nephrology Endocrinology and Vascular Medicine Tohoku University Hospital Sendai Japan

Endocrinology in Charlottenburg 10627 Berlin Germany

Endocrinology Unit Monash Health Clayton Victoria Australia

Faculty of Medicine University of Ljubljana Ljubljana Slovenia

Foothills Medical Center University of Calgary Calgary Alberta Canada

Heinrich Heine University Düsseldorf Nephrologie 40225 Düsseldorf Germany

Medical College of Wisconsin Endocrinology Center North Hills Health Center Menomonee Falls Wisconsin USA

Medizinische Klinik und Poliklinik 4 Klinikum der Universität München LMU München Munich Germany

Université de Paris INSERM CIC1418 and UMR 970 Paris France

University of Padova Department of Medicine DIMED Institute of Radiology University Hospital Padova Italy

University of Padova Department of Medicine DIMED International PhD Program in Arterial Hypertension and Vascular Biology University Hospital Padova Italy

Citace poskytuje Crossref.org

Validation of Existing Clinical Prediction Tools for Primary Aldosteronism Subtyping

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ClinicalTrials.gov
NCT01234220