BACKGROUND: Adrenal venous sampling is recommended for the identification of unilateral surgically curable primary aldosteronism but is often clinically useless, owing to failed bilateral adrenal vein cannulation. OBJECTIVES: To investigate if only unilaterally selective adrenal vein sampling studies can allow the identification of the responsible adrenal. METHODS: Among 1625 patients consecutively submitted to adrenal vein sampling in tertiary referral centers, we selected those with selective adrenal vein sampling results in at least one side; we used surgically cured unilateral primary aldosteronism as gold reference. The accuracy of different values of the relative aldosterone secretion index (RASI), which estimates the amount of aldosterone produced in each adrenal gland corrected for catheterization selectivity, was examined. RESULTS: We found prominent differences in RASI values distribution between patients with and without unilateral primary aldosteronism. The diagnostic accuracy of RASI values estimated by the area under receiver operating characteristic curves was 0.714 and 0.855, respectively, in the responsible and the contralateral side; RASI values >2.55 and ≤0.96 on the former and the latter side furnished the highest accuracy for detection of surgically cured unilateral primary aldosteronism. Moreover, in the patients without unilateral primary aldosteronism, only 20% and 16% had RASI values ≤0.96 and >2.55. CONCLUSIONS: With the strength of a large real-life data set and use of the gold reference entailing an unambiguous diagnosis of unilateral primary aldosteronism, these results indicate the feasibility of identifying unilateral primary aldosteronism using unilaterally selective adrenal vein sampling results. REGISTRATION: URL: https://www. CLINICALTRIALS: gov; Unique identifier: NCT01234220.

3rd Department of Medicine Department of Endocrinology and Metabolism 1st Faculty of Medicine and General University Hospital Prague Czech Republic

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

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

Department of Endocrinology University of St Petersburg Russia

Department of Internal Medicine National Taiwan University Hospital and National Taiwan University College of Medicine Taipei

Department of Internal Medicine Radboud University Medical Center Nijmegen The Netherlands

Department of Medical Imaging National Taiwan University Hospital Taipei

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

Department of Nephrology Medical Faculty University Hospital Düsseldorf Heinrich Heine University Düsseldorf Germany

Division of Endocrinology and Metabolism Rostock University Medical Center Rostock Germany

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

Endocrinology in Charlottenburg Berlin Germany

Foothills Medical Centre University of Calgary Canada

Hypertension Unit Department of Medicine DIMED University Hospital University of Padova Italy

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

Institute of Cardiovascular and Medical Sciences University of Glasgow United Kingdom

Institute of Radiology University of Padua Padova Italy

Internal Medicine and Hypertension Center Ospedale Sant'Anna di Castelnovo Ne' Monti Azienda Usl IRCCS di Reggio Emilia

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

Monash Health Clayton VIC Australia

National Taiwan University College of Medicine Taipei

Université Paris Cité INSERM UMRS 970 and CIC1418 F 75015 Paris France; AP HP Hôpital Européen Georges Pompidou Hypertension Unit F 75015 Paris France

University Medical Centre Ljubljana Ljubljana Slovenia; Faculty of Medicine University of Ljubljana Ljubljana Slovenia

Hypertension. 2023 Oct;80(10):2014-2016. doi: 10.1161/HYPERTENSIONAHA.123.21563. PubMed

References provided by Crossref.org

Subtype Identification of Surgically Curable Primary Aldosteronism During Treatment With Mineralocorticoid Receptor Blockade

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NCT01234220