The new clinical prediction score (SCORE) has been recently proposed for primary aldosteronism (PA) subtyping prior to adrenal vein sampling (AVS). This study aimed to compare that SCORE with previously published scores and their validation using a cohort of patients at our center who had had positive SIT confirming PA and had been diagnosed with either bilateral PA according to AVS or unilateral PA if biochemically cured after an adrenalectomy. Final diagnoses were used to evaluate the diagnostic performance of the proposed clinical prediction tools. Only Kamemura's model (with a maximum score of 4 points) and Kobayashi's score (with a maximum score of 12 points) reached 100% reliability for prediction of bilateral PA; however, with sensitivity of only 3%. On the other hand, the values of SCORE = 3 (with sensitivity of 48%), the SPACE score ≥18 (with sensitivity of 35%), the Kobayashi's score ≤2 (with sensitivity of 28%), and the Kocjan's score = 3 (with sensitivity of 28%) were able to predict unilateral PA with 100% probability. Furthermore, Umakoshi's and Young's models both reached 100% reliability for a unilateral PA with score = 4 and both predictive factors together respectively; however, the sensitivity was lower compared with previous models; 4% and 14%, respectively. None of the clinical prediction tools applied to our cohort predicted unilateral and bilateral subtypes together with the expected high diagnostic performance, and therefore can only be used for precisely defined cases.

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

Department of Anesthesiology University Hospital Královské Vinohrady and 3rd Faculty of Medicine Charles University Prague 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 Prague U Nemocnice 504 1 128 08 Prague Czech Republic

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Kaplan N.M. Primary aldosteronism. In: Kaplan N.M., editor. Kaplan’s Clinical Hypertension. Lippincott Williams & Wilkins; Philadelphia, PA, USA: 2006. pp. 410–433.

Rizzoni D., Paiardi S., Rodella L., Porteri E., De Ciuceis C., Rezzani R., Boari G.E.M., Zani F., Miclini M., Tiberio G.A.M., et al. Changes in Extracellular Matrix in Subcutaneous Small Resistance Arteries of Patients with Primary Aldosteronism. J. Clin. Endocrinol. Metab. 2006;91:2638–2642. doi: 10.1210/jc.2006-0101. PubMed DOI

Štrauch B., Petrák O., Wichterle D., Zelinka T., Holaj R., Widimský J., Jr. Increased arterial wall stiffness in primary aldosteronism in comparison with essential hypertension. Am. J. Hypertens. 2006;19:909–914. doi: 10.1016/j.amjhyper.2006.02.002. PubMed DOI

Rossi G.P., Di Bello V., Ganzaroli C., Sacchetto A., Cesari M., Bertini A., Giorgi D., Scognamiglio R., Mariani M., Pessina A.C. Excess aldosterone is associated with alterations of myocardial texture in primary aldosteronism. Hypertension. 2002;40:23–27. doi: 10.1161/01.HYP.0000023182.68420.EB. PubMed DOI

Holaj R., Zelinka T., Wichterle D., Petrák O., Štrauch B., Widimský J., Jr. Increased intima-media thickness of the common carotid artery in primary aldosteronism in comparison with essential hypertension. J. Hypertens. 2007;25:1451–1457. doi: 10.1097/HJH.0b013e3281268532. PubMed DOI

Schmidt B.M., Schmieder R.E. Aldosterone-induced cardiac damage: Focus on blood pressure independent effects. Am. J. Hypertens. 2003;16:80–86. doi: 10.1016/S0895-7061(02)03199-0. PubMed DOI

Indra T., Holaj R., Zelinka T., Petrák O., Štrauch B., Rosa J., Šomlóová Z., Malík J., Janota T., Hradec J., et al. Left ventricle remodeling in men with moderate to severe volume-dependent hypertension. J. Renin Angiotensin Aldosterone Syst. 2012;13:426–434. doi: 10.1177/1470320312446240. PubMed DOI

Catena C., Colussi G., Brosolo G., Novello M., Sechi L.A. Aldosterone and Left Ventricular Remodeling. Horm. Metab. Res. 2015;47:981–986. doi: 10.1055/s-0035-1565055. PubMed DOI

Fardella C.E., Mosso L., Gomez-Sanchez C., Cortes P., Soto J., Gomez L., Pinto M., Huete A., Oestreicher E., Foradori A., et al. Primary hyperaldosteronism in essential hypertensives: Prevalence, biochemical profile, and molecular biology. J. Clin. Endocrinol. Metab. 2000;85:1863–1867. doi: 10.1210/jc.85.5.1863. PubMed DOI

Rossi G.P., Bernini G., Caliumi C., Desideri G., Fabris B., Ferri C., Ganzaroli C., Giacchetti G., Letizia C., Maccario M., et al. A prospective study of the prevalence of primary aldosteronism in 1,125 hypertensive patients. J. Am. Coll. Cardiol. 2006;48:2293–2300. doi: 10.1016/j.jacc.2006.07.059. PubMed DOI

Kayser S.C., Deinum J., de Grauw W.J., Schalk B.W., Bor H.J., Lenders J.W., Schermer T.R., Biermans M.C. Prevalence of primary aldosteronism in primary care: A cross-sectional study. Br. J. Gen. Pract. 2018;68:e114–e122. doi: 10.3399/bjgp18X694589. PubMed DOI PMC

Štrauch B., Zelinka T., Hampf M., Bernhardt R., Widimský J., Jr. Prevalence of primary hyperaldosteronism in moderate to severe hypertension in the Central Europe region. J. Hum. Hypertens. 2003;17:349–352. doi: 10.1038/sj.jhh.1001554. PubMed DOI

Brown J.M., Siddiqui M., Calhoun D.A., Carey R.M., Hopkins P.N., Williams G.H., Vaidya A. The Unrecognized Prevalence of Primary Aldosteronism: A Cross-sectional Study. Ann. Intern. Med. 2020;173:10–20. doi: 10.7326/M20-0065. PubMed DOI PMC

Parasiliti-Caprino M., Lopez C., Prencipe N., Lucatello B., Settanni F., Giraudo G., Rossato D., Mengozzi G., Ghigo E., Benso A., et al. Prevalence of primary aldosteronism and association with cardiovascular complications in patients with resistant and refractory hypertension. J. Hypertens. 2020;38:1841–1848. doi: 10.1097/HJH.0000000000002441. PubMed DOI

Funder J.W., Carey R.M., Mantero F., Murad M.H., Reincke M., Shibata H., Stowasser M., Young W.F., Jr. The Management of Primary Aldosteronism: Case Detection, Diagnosis, and Treatment: An Endocrine Society Clinical Practice Guideline. J. Clin. Endocrinol. Metab. 2016;101:1889–1916. doi: 10.1210/jc.2015-4061. PubMed DOI

Conn J.W. The evolution of primary aldosteronism: 1954–1967. Harvey Lect. 1966;62:257–291. PubMed

Zelinka T., Masek M., Vlkova J., Kasalicky M., Michalsky D., Holaj R., Petrak O., Strauch B., Rosa J., Dvorakova J., et al. Discrepant results of adrenal venous sampling in seven patients with primary aldosteronism. Kidney Blood Press. Res. 2012;35:205–210. doi: 10.1159/000330720. PubMed DOI

Rossi G.P., Auchus R.J., Brown M., Lenders J.W., Naruse M., Plouin P.F., Satoh F., Young W.F., Jr. An expert consensus statement on use of adrenal vein sampling for the subtyping of primary aldosteronism. Hypertension. 2014;63:151–160. doi: 10.1161/HYPERTENSIONAHA.113.02097. PubMed DOI

Stowasser M. Adrenal venous sampling for differentiating unilateral from bilateral primary aldosteronism: Still the best, but could be better. Hypertension. 2015;65:704–706. doi: 10.1161/HYPERTENSIONAHA.115.04930. PubMed DOI

Kupers E.M., Amar L., Raynaud A., Plouin P.F., Steichen O. A clinical prediction score to diagnose unilateral primary aldosteronism. J. Clin. Endocrinol. Metab. 2012;97:3530–3537. doi: 10.1210/jc.2012-1917. PubMed DOI

Nanba K., Tsuiki M., Nakao K., Nanba A., Usui T., Tagami T., Hirokawa Y., Okuno H., Suzuki T., Shimbo T., et al. A subtype prediction score for primary aldosteronism. J. Hum. Hypertens. 2014;28:716–720. doi: 10.1038/jhh.2014.20. PubMed DOI

Kocjan T., Janez A., Stankovic M., Vidmar G., Jensterle M. A New Clinical Prediction Criterion Accurately Determines a Subset of Patients with Bilateral Primary Aldosteronism before Adrenal Venous Sampling. Endocr. Pract. 2016;22:587–594. doi: 10.4158/EP15982.OR. PubMed DOI

Kamemura K., Wada N., Ichijo T., Matsuda Y., Fujii Y., Kai T., Fukuoka T., Sakamoto R., Ogo A., Suzuki T., et al. Significance of adrenal computed tomography in predicting laterality and indicating adrenal vein sampling in primary aldosteronism. J. Hum. Hypertens. 2016;31:195–199. doi: 10.1038/jhh.2016.61. PubMed DOI

Kobayashi H., Abe M., Soma M., Takeda Y., Kurihara I., Itoh H., Umakoshi H., Tsuiki M., Katabami T., Ichijo T., et al. Development and validation of subtype prediction scores for the workup of primary aldosteronism. J. Hypertens. 2018;36:2269–2276. doi: 10.1097/HJH.0000000000001855. PubMed DOI

Puar T.H., Loh W.J., Lim D.S., Loh L.M., Zhang M., Foo R.S., Lee L., Swee D.S., Khoo J., Tay D., et al. Aldosterone-potassium ratio predicts primary aldosteronism subtype. J. Hypertens. 2020;38:1375–1383. doi: 10.1097/HJH.0000000000002348. PubMed DOI

Nagano H., Kono T., Saiga A., Kubota Y., Fujimoto M., Felizola S.J.A., Ishiwata K., Tamura A., Higuchi S., Sakuma I., et al. Aldosterone Reduction Rate After Saline Infusion Test May Be a Novel Prediction in Patients With Primary Aldosteronism. J. Clin. Endocrinol. Metab. 2020;105:e319–e327. doi: 10.1210/clinem/dgz092. PubMed DOI

Burrello J., Amongero M., Buffolo F., Sconfienza E., Forestiero V., Burrello A., Adolf C., Handgriff L., Reincke M., Veglio F., et al. Development of a Prediction Score to Avoid Confirmatory Testing in Patients With Suspected Primary Aldosteronism. J. Clin. Endocrinol. Metab. 2021;106:e1708–e1716. doi: 10.1210/clinem/dgaa974. PubMed DOI

Lee S.H., Kim J.W., Yoon H.K., Koh J.M., Shin C.S., Kim S.W., Kim J.H. Diagnostic Accuracy of Computed Tomography in Predicting Primary Aldosteronism Subtype According to Age. Endocrinol. Metab. 2021;36:401–412. doi: 10.3803/EnM.2020.901. PubMed DOI PMC

Young W.F., Stanson A.W., Thompson G.B., Grant C.S., Farley D.R., van Heerden J.A. Role for adrenal venous sampling in primary aldosteronism. Surgery. 2004;136:1227–1235. doi: 10.1016/j.surg.2004.06.051. PubMed DOI

Kaneko H., Umakoshi H., Ishihara Y., Sugawa T., Nanba K., Tsuiki M., Kusakabe T., Satoh-Asahara N., Yasoda A., Tagami T. Seated saline infusion test in predicting subtype diagnosis of primary aldosteronism. Clin. Endocrinol. 2019;91:737–742. doi: 10.1111/cen.14111. PubMed DOI

Umakoshi H., Ogasawara T., Takeda Y., Kurihara I., Itoh H., Katabami T., Ichijo T., Wada N., Shibayama Y., Yoshimoto T., et al. Accuracy of adrenal computed tomography in predicting the unilateral subtype in young patients with hypokalaemia and elevation of aldosterone in primary aldosteronism. Clin. Endocrinol. 2018;88:645–651. doi: 10.1111/cen.13582. PubMed DOI

Rossi G.P., Crimi F., Rossitto G., Amar L., Azizi M., Riester A., Reincke M., Degenhart C., Widimsky J., Naruse M., et al. Identification of Surgically Curable Primary Aldosteronism by Imaging in a Large, Multiethnic International Study. J. Clin. Endocrinol. Metab. 2021;106:e4340–e4349. doi: 10.1210/clinem/dgab482. PubMed DOI

Song Y., Yang J., Shen H., Ng E., Fuller P.J., Feng Z., Hu J., Ma L., Yang Y., Du Z., et al. Development and validation of model for sparing adrenal venous sampling in diagnosing unilateral primary aldosteronism. J. Hypertens. 2022;40:1692–1701. doi: 10.1097/HJH.0000000000003197. PubMed DOI

Holaj R., Waldauf P., Wichterle D., Kvasnicka J., Zelinka T., Petrak O., Kratka Z., Forejtova L., Kavan J., Widimsky J., Jr. Adrenal Venous Sampling Could Be Omitted before Surgery in Patients with Conn’s Adenoma Confirmed by Computed Tomography and Higher Normal Aldosterone Concentration after Saline Infusion Test. Diagnostics. 2022;12:1718. doi: 10.3390/diagnostics12071718. PubMed DOI PMC

Stowasser M., Ahmed A.H., Pimenta E., Taylor P.J., Gordon R.D. Factors affecting the aldosterone/renin ratio. Horm. Metab. Res. 2012;44:170–176. doi: 10.1055/s-0031-1295460. PubMed DOI

Vincent J.M., Morrison I.D., Armstrong P., Reznek R.H. The size of normal adrenal glands on computed tomography. Clin. Radiol. 1994;49:453–455. doi: 10.1016/S0009-9260(05)81739-8. PubMed DOI

Young W.F., Jr. Clinical practice. The incidentally discovered adrenal mass. N. Engl. J. Med. 2007;356:601–610. doi: 10.1056/NEJMcp065470. PubMed DOI

Campbell R.A., Young D.S., Shaver C.N., Snyder S.K., Milan S.A., Lairmore T.C., McDonald D.K. Influence of Adrenal Venous Sampling on Management in Patients with Primary Aldosteronism Independent of Lateralization on Cross-Sectional Imaging. J. Am. Coll. Surg. 2019;229:116–124. doi: 10.1016/j.jamcollsurg.2019.03.012. PubMed DOI

Rossi G.P., Barisa M., Allolio B., Auchus R.J., Amar L., Cohen D., Degenhart C., Deinum J., Fischer E., Gordon R., et al. The Adrenal Vein Sampling International Study (AVIS) for identifying the major subtypes of primary aldosteronism. J. Clin. Endocrinol. Metab. 2012;97:1606–1614. doi: 10.1210/jc.2011-2830. PubMed DOI

Mulatero P., Sechi L.A., Williams T.A., Lenders J.W.M., Reincke M., Satoh F., Januszewicz A., Naruse M., Doumas M., Veglio F., et al. Subtype diagnosis, treatment, complications and outcomes of primary aldosteronism and future direction of research: A position statement and consensus of the Working Group on Endocrine Hypertension of the European Society of Hypertension. J. Hypertens. 2020;38:1929–1936. doi: 10.1097/HJH.0000000000002520. PubMed DOI

Williams T.A., Lenders J.W.M., Mulatero P., Burrello J., Rottenkolber M., Adolf C., Satoh F., Amar L., Quinkler M., Deinum J., et al. Outcomes after adrenalectomy for unilateral primary aldosteronism: An international consensus on outcome measures and analysis of remission rates in an international cohort. Lancet Diabetes Endocrinol. 2017;5:689–699. doi: 10.1016/S2213-8587(17)30135-3. PubMed DOI PMC

Satoh F., Abe T., Tanemoto M., Nakamura M., Abe M., Uruno A., Morimoto R., Sato A., Takase K., Ishidoya S., et al. Localization of aldosterone-producing adrenocortical adenomas: Significance of adrenal venous sampling. Hypertens. Res. 2007;30:1083–1095. doi: 10.1291/hypres.30.1083. PubMed DOI

Kocjan T., Vidmar G., Popovic P., Stankovic M. Validation of three novel clinical prediction tools for primary aldosteronism subtyping. Endocr. Connect. 2022;11:e210532. doi: 10.1530/EC-21-0532. PubMed DOI PMC

Kobayashi H., Haketa A., Ueno T., Ikeda Y., Hatanaka Y., Tanaka S., Otsuka H., Abe M., Fukuda N., Soma M. Scoring system for the diagnosis of bilateral primary aldosteronism in the outpatient setting before adrenal venous sampling. Clin. Endocrinol. 2017;86:467–472. doi: 10.1111/cen.13278. PubMed DOI

Weigel M., Riester A., Hanslik G., Lang K., Willenberg H.S., Endres S., Allolio B., Beuschlein F., Reincke M., Quinkler M. Post-saline infusion test aldosterone levels indicate severity and outcome in primary aldosteronism. Eur. J. Endocrinol. 2015;172:443–450. doi: 10.1530/EJE-14-1013. PubMed DOI

Kitamoto T., Omura M., Suematsu S., Saito J., Nishikawa T. KCNJ5 mutation as a predictor for resolution of hypertension after surgical treatment of aldosterone-producing adenoma. J. Hypertens. 2018;36:619–627. doi: 10.1097/HJH.0000000000001578. PubMed DOI

Williams T.A., Monticone S., Mulatero P. KCNJ5 Mutations Are the Most Frequent Genetic Alteration in Primary Aldosteronism. Hypertension. 2015;65:507–509. doi: 10.1161/HYPERTENSIONAHA.114.04636. PubMed DOI