PURPOSE: Adrenal venous sampling (AVS) performed to distinguish unilateral and bilateral primary aldosteronism (PA) is invasive and poorly standardized. This study aimed to identify non-invasive characteristics that can select the patients with unilateral PA who could bypass AVS before surgery. METHODS: A single-center study collected a total of 450 patients with PA. Development and validation cohorts included 242 and 208 patients. The AVS was successful in 150 and 138 patients from the cohorts, and the unilateral PA was found in 96 and 94 patients, respectively. Clinical factors independently associated with lateralized AVS in multivariable logistic regression were used to construct a unilateral PA prediction score (SCORE). RESULTS: The proposed SCORE was calculated as a sum of the prevalence of adrenal nodule on computed tomography (2 points) and plasma/serum aldosterone concentration ≥ 165 ng/L after the saline infusion test (SIT) (1 point). Importantly, the SCORE = 3 points identified 48% of unilateral PA patients with a specificity of 100% in the development cohort. The zero rate of false-positive classifications was preserved with the same cut-off value in the validation cohort. CONCLUSIONS: AVS could be omitted before surgery in patients with typical Conn´s adenoma provided the aldosterone concentration ≥ 165 ng/L after the SIT.

Centre for Hypertension 3rd Department of Medicine General University Hospital and 1st Faculty of Medicine Charles University U Nemocnice 504 1 128 08 Prague Czech Republic

Department of Anesthesiology University Hospital Královské Vinohrady and 3rd Faculty of Medicine Charles University Šrobárova 1150 50 100 00 Prague Czech Republic

Department of Cardiology Institute for Clinical and Experimental Medicine Vídeňská 1958 9 140 21 Prague Czech Republic

Department of Radiology General University Hospital and 1st Faculty of Medicine Charles University U Nemocnice 499 2 128 08 Prague Czech Republic

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Validation of Existing Clinical Prediction Tools for Primary Aldosteronism Subtyping