A clinical decision model for failed adrenal vein sampling in primary aldosteronism
ObjectivePrimary aldosteronism (PA) is a common cause of secondary hypertension with unilateral and bilateral subtypes requiring different treatments. Adrenal vein sampling (AVS) is the gold standard for subtype differentiation but can be unsuccessful by challenging right adrenal vein anatomy. This...
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Frontiers Media S.A.
2025-01-01
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| Series: | Frontiers in Endocrinology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fendo.2024.1497787/full |
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| author | Sophie N. M. ter Haar Sofie J. van Goor Eleonora P. M. Corssmit Arian R. van Erkel Bartholomeus E. P. B. Ballieux Olaf M. Dekkers Olaf M. Dekkers Michiel F. Nijhoff |
| author_facet | Sophie N. M. ter Haar Sofie J. van Goor Eleonora P. M. Corssmit Arian R. van Erkel Bartholomeus E. P. B. Ballieux Olaf M. Dekkers Olaf M. Dekkers Michiel F. Nijhoff |
| author_sort | Sophie N. M. ter Haar |
| collection | DOAJ |
| description | ObjectivePrimary aldosteronism (PA) is a common cause of secondary hypertension with unilateral and bilateral subtypes requiring different treatments. Adrenal vein sampling (AVS) is the gold standard for subtype differentiation but can be unsuccessful by challenging right adrenal vein anatomy. This study aimed to develop a clinical decision model using only measurements from the left adrenal vein (LAV) and peripheral blood (IVC) to differentiate between PA subtypes.MethodsThe retrospective cohort study included 54 PA patients who underwent bilaterally successful AVS. The main objective was to determine optimal cut-off values for the LAV/IVC index, using ROC analysis for subtype prediction. The predictive value of this index was assessed with the Area Under the Curve (AUC). The Youden index calculated cut-off values, targeting a specificity >90% for PA subtype differentiation.ResultsThe cohort, averaging 48.5 ± 9.5 years in age, comprised 21 women and 33 men, among whom 26 presented with unilateral and 28 with bilateral disease. LAV/IVC values <1.2 indicated unilateral right-sided disease (specificity 91%, sensitivity 96%, AUC 0.98, 95% confidence interval (CI) 0.95-1.0), values 1.2-2.4 suggested bilateral disease (sensitivity 93%, specificity 64%, AUC 0.85, CI 0.73-0.96), whereas values ≥4.4 predicted unilateral left-sided disease (specificity 93%, sensitivity 60%, AUC 0.85, CI 0.73-0.96). Published literature aligns with our results on cut-off values.ConclusionsUtilizing the LAV/IVC index, over 70% of unsuccessful AVS procedures due to failed right adrenal cannulation could be interpreted with over 90% certainty regarding the PA subtype, preventing unnecessary resampling and aiding in determining the preferred treatment. |
| format | Article |
| id | doaj-art-f40815f2b6154de4b8f1d35a3f6a44df |
| institution | Kabale University |
| issn | 1664-2392 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Frontiers Media S.A. |
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| series | Frontiers in Endocrinology |
| spelling | doaj-art-f40815f2b6154de4b8f1d35a3f6a44df2025-01-17T05:10:46ZengFrontiers Media S.A.Frontiers in Endocrinology1664-23922025-01-011510.3389/fendo.2024.14977871497787A clinical decision model for failed adrenal vein sampling in primary aldosteronismSophie N. M. ter Haar0Sofie J. van Goor1Eleonora P. M. Corssmit2Arian R. van Erkel3Bartholomeus E. P. B. Ballieux4Olaf M. Dekkers5Olaf M. Dekkers6Michiel F. Nijhoff7Department of Medicine, Division of Endocrinology and Metabolism, Leiden University Medical Center, Leiden, NetherlandsDepartment of Medicine, Division of Endocrinology and Metabolism, Leiden University Medical Center, Leiden, NetherlandsDepartment of Medicine, Division of Endocrinology and Metabolism, Leiden University Medical Center, Leiden, NetherlandsDepartment of Radiology, Leiden University Medical Center, Leiden, NetherlandsDepartment of Clinical Chemistry and Laboratory Medicine, Leiden University Medical Center, Leiden, NetherlandsDepartment of Medicine, Division of Endocrinology and Metabolism, Leiden University Medical Center, Leiden, NetherlandsDepartment of Clinical Epidemiology, Leiden University Medical Centre, Leiden, NetherlandsDepartment of Medicine, Division of Endocrinology and Metabolism, Leiden University Medical Center, Leiden, NetherlandsObjectivePrimary aldosteronism (PA) is a common cause of secondary hypertension with unilateral and bilateral subtypes requiring different treatments. Adrenal vein sampling (AVS) is the gold standard for subtype differentiation but can be unsuccessful by challenging right adrenal vein anatomy. This study aimed to develop a clinical decision model using only measurements from the left adrenal vein (LAV) and peripheral blood (IVC) to differentiate between PA subtypes.MethodsThe retrospective cohort study included 54 PA patients who underwent bilaterally successful AVS. The main objective was to determine optimal cut-off values for the LAV/IVC index, using ROC analysis for subtype prediction. The predictive value of this index was assessed with the Area Under the Curve (AUC). The Youden index calculated cut-off values, targeting a specificity >90% for PA subtype differentiation.ResultsThe cohort, averaging 48.5 ± 9.5 years in age, comprised 21 women and 33 men, among whom 26 presented with unilateral and 28 with bilateral disease. LAV/IVC values <1.2 indicated unilateral right-sided disease (specificity 91%, sensitivity 96%, AUC 0.98, 95% confidence interval (CI) 0.95-1.0), values 1.2-2.4 suggested bilateral disease (sensitivity 93%, specificity 64%, AUC 0.85, CI 0.73-0.96), whereas values ≥4.4 predicted unilateral left-sided disease (specificity 93%, sensitivity 60%, AUC 0.85, CI 0.73-0.96). Published literature aligns with our results on cut-off values.ConclusionsUtilizing the LAV/IVC index, over 70% of unsuccessful AVS procedures due to failed right adrenal cannulation could be interpreted with over 90% certainty regarding the PA subtype, preventing unnecessary resampling and aiding in determining the preferred treatment.https://www.frontiersin.org/articles/10.3389/fendo.2024.1497787/fullprimary aldosteronismadrenal vein samplingLAV/IVC indexdisease subtypefailed right cannulationadrenalectomy |
| spellingShingle | Sophie N. M. ter Haar Sofie J. van Goor Eleonora P. M. Corssmit Arian R. van Erkel Bartholomeus E. P. B. Ballieux Olaf M. Dekkers Olaf M. Dekkers Michiel F. Nijhoff A clinical decision model for failed adrenal vein sampling in primary aldosteronism Frontiers in Endocrinology primary aldosteronism adrenal vein sampling LAV/IVC index disease subtype failed right cannulation adrenalectomy |
| title | A clinical decision model for failed adrenal vein sampling in primary aldosteronism |
| title_full | A clinical decision model for failed adrenal vein sampling in primary aldosteronism |
| title_fullStr | A clinical decision model for failed adrenal vein sampling in primary aldosteronism |
| title_full_unstemmed | A clinical decision model for failed adrenal vein sampling in primary aldosteronism |
| title_short | A clinical decision model for failed adrenal vein sampling in primary aldosteronism |
| title_sort | clinical decision model for failed adrenal vein sampling in primary aldosteronism |
| topic | primary aldosteronism adrenal vein sampling LAV/IVC index disease subtype failed right cannulation adrenalectomy |
| url | https://www.frontiersin.org/articles/10.3389/fendo.2024.1497787/full |
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