Significance of computed tomography and serum potassium in predicting subtype diagnosis of primary aldosteronism

Hironobu Umakoshi, Mika Tsuiki, Yoshiyu Takeda, Isao Kurihara, Hiroshi Itoh, Takuyuki Katabami, Takamasa Ichijo, Norio Wada, Takanobu Yoshimoto, Yoshihiro Ogawa, Junji Kawashima, Masakatsu Sone, Nobuya Inagaki, Katsutoshi Takahashi, Minemori Watanabe, Yuichi Matsuda, Hiroki Kobayashi, Hirotaka Shibata, Kohei Kamemura, Michio OtsukiYuichi Fujii, Koichi Yamamto, Atsushi Ogo, Toshihiko Yanase, Tomoko Suzuki, Mitsuhide Naruse, Study Group JPAS Study Group

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

Context: The number of centers with established adrenal venous sampling (AVS) programs for the subtype diagnosis of primary aldosteronism (PA) is limited. Objective: Aim was to develop an algorithm for AVS based on subtype prediction by computed tomography (CT) and serum potassium. Design: A multi-institutional retrospective cohort study in Japan. Patients: A total of 1591 patients with PA were classified into four groups according to CT findings and potassium status. Subtype diagnosis of PA was determined by AVS. Main Outcome Measure: Prediction value of the combination of CT findings and potassium status for subtype diagnosis. Results: The percentages of unilateral hyperaldosteronism on AVS were higher in patients with unilateral disease on CT than those with bilateral normal results on CT (50.8% vs 14.6%, P, 0.01), and these percentages were higher in those with hypokalemia than those with normokalemia (58.4% vs 11.5%, P, 0.01). The prevalence and odds ratio for unilateral hyperaldosteronism on AVS were as follows: bilateral normal on CT with normokalemia, 6.2% (reference); unilateral disease on CT with normokalemia, 23.8% and 4.8 [95% confidence interval (CI), 3.1 to 7.2]; bilateral normal on CT with hypokalemia, 38.1% and 9.4 (95% CI, 6.2 to 14.1), and unilateral disease on CT with hypokalemia, 70.6% and 36.4 (95% CI, 24.7 to 53.5). Conclusions: Patients with PA with bilateral normal results on CT and normokalemia likely have a low prior probability of a lateralized form of AVS and could be treated medically, whereas those with unilateral disease on CT and hypokalemia have a high probability of a lateralized form of AVS.

Original languageEnglish
Pages (from-to)900-908
Number of pages9
JournalJournal of Clinical Endocrinology and Metabolism
Volume103
Issue number3
DOIs
Publication statusPublished - Jan 1 2018

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Hyperaldosteronism
Tomography
Potassium
Serum
Sampling
Hypokalemia
Confidence Intervals
Japan
Cohort Studies
Retrospective Studies
Odds Ratio
Outcome Assessment (Health Care)

All Science Journal Classification (ASJC) codes

  • Endocrinology, Diabetes and Metabolism
  • Biochemistry
  • Endocrinology
  • Clinical Biochemistry
  • Biochemistry, medical

Cite this

Umakoshi, H., Tsuiki, M., Takeda, Y., Kurihara, I., Itoh, H., Katabami, T., ... JPAS Study Group, S. G. (2018). Significance of computed tomography and serum potassium in predicting subtype diagnosis of primary aldosteronism. Journal of Clinical Endocrinology and Metabolism, 103(3), 900-908. https://doi.org/10.1210/jc.2017-01774

Significance of computed tomography and serum potassium in predicting subtype diagnosis of primary aldosteronism. / Umakoshi, Hironobu; Tsuiki, Mika; Takeda, Yoshiyu; Kurihara, Isao; Itoh, Hiroshi; Katabami, Takuyuki; Ichijo, Takamasa; Wada, Norio; Yoshimoto, Takanobu; Ogawa, Yoshihiro; Kawashima, Junji; Sone, Masakatsu; Inagaki, Nobuya; Takahashi, Katsutoshi; Watanabe, Minemori; Matsuda, Yuichi; Kobayashi, Hiroki; Shibata, Hirotaka; Kamemura, Kohei; Otsuki, Michio; Fujii, Yuichi; Yamamto, Koichi; Ogo, Atsushi; Yanase, Toshihiko; Suzuki, Tomoko; Naruse, Mitsuhide; JPAS Study Group, Study Group.

In: Journal of Clinical Endocrinology and Metabolism, Vol. 103, No. 3, 01.01.2018, p. 900-908.

Research output: Contribution to journalArticle

Umakoshi, H, Tsuiki, M, Takeda, Y, Kurihara, I, Itoh, H, Katabami, T, Ichijo, T, Wada, N, Yoshimoto, T, Ogawa, Y, Kawashima, J, Sone, M, Inagaki, N, Takahashi, K, Watanabe, M, Matsuda, Y, Kobayashi, H, Shibata, H, Kamemura, K, Otsuki, M, Fujii, Y, Yamamto, K, Ogo, A, Yanase, T, Suzuki, T, Naruse, M & JPAS Study Group, SG 2018, 'Significance of computed tomography and serum potassium in predicting subtype diagnosis of primary aldosteronism', Journal of Clinical Endocrinology and Metabolism, vol. 103, no. 3, pp. 900-908. https://doi.org/10.1210/jc.2017-01774
Umakoshi, Hironobu ; Tsuiki, Mika ; Takeda, Yoshiyu ; Kurihara, Isao ; Itoh, Hiroshi ; Katabami, Takuyuki ; Ichijo, Takamasa ; Wada, Norio ; Yoshimoto, Takanobu ; Ogawa, Yoshihiro ; Kawashima, Junji ; Sone, Masakatsu ; Inagaki, Nobuya ; Takahashi, Katsutoshi ; Watanabe, Minemori ; Matsuda, Yuichi ; Kobayashi, Hiroki ; Shibata, Hirotaka ; Kamemura, Kohei ; Otsuki, Michio ; Fujii, Yuichi ; Yamamto, Koichi ; Ogo, Atsushi ; Yanase, Toshihiko ; Suzuki, Tomoko ; Naruse, Mitsuhide ; JPAS Study Group, Study Group. / Significance of computed tomography and serum potassium in predicting subtype diagnosis of primary aldosteronism. In: Journal of Clinical Endocrinology and Metabolism. 2018 ; Vol. 103, No. 3. pp. 900-908.
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abstract = "Context: The number of centers with established adrenal venous sampling (AVS) programs for the subtype diagnosis of primary aldosteronism (PA) is limited. Objective: Aim was to develop an algorithm for AVS based on subtype prediction by computed tomography (CT) and serum potassium. Design: A multi-institutional retrospective cohort study in Japan. Patients: A total of 1591 patients with PA were classified into four groups according to CT findings and potassium status. Subtype diagnosis of PA was determined by AVS. Main Outcome Measure: Prediction value of the combination of CT findings and potassium status for subtype diagnosis. Results: The percentages of unilateral hyperaldosteronism on AVS were higher in patients with unilateral disease on CT than those with bilateral normal results on CT (50.8{\%} vs 14.6{\%}, P, 0.01), and these percentages were higher in those with hypokalemia than those with normokalemia (58.4{\%} vs 11.5{\%}, P, 0.01). The prevalence and odds ratio for unilateral hyperaldosteronism on AVS were as follows: bilateral normal on CT with normokalemia, 6.2{\%} (reference); unilateral disease on CT with normokalemia, 23.8{\%} and 4.8 [95{\%} confidence interval (CI), 3.1 to 7.2]; bilateral normal on CT with hypokalemia, 38.1{\%} and 9.4 (95{\%} CI, 6.2 to 14.1), and unilateral disease on CT with hypokalemia, 70.6{\%} and 36.4 (95{\%} CI, 24.7 to 53.5). Conclusions: Patients with PA with bilateral normal results on CT and normokalemia likely have a low prior probability of a lateralized form of AVS and could be treated medically, whereas those with unilateral disease on CT and hypokalemia have a high probability of a lateralized form of AVS.",
author = "Hironobu Umakoshi and Mika Tsuiki and Yoshiyu Takeda and Isao Kurihara and Hiroshi Itoh and Takuyuki Katabami and Takamasa Ichijo and Norio Wada and Takanobu Yoshimoto and Yoshihiro Ogawa and Junji Kawashima and Masakatsu Sone and Nobuya Inagaki and Katsutoshi Takahashi and Minemori Watanabe and Yuichi Matsuda and Hiroki Kobayashi and Hirotaka Shibata and Kohei Kamemura and Michio Otsuki and Yuichi Fujii and Koichi Yamamto and Atsushi Ogo and Toshihiko Yanase and Tomoko Suzuki and Mitsuhide Naruse and {JPAS Study Group}, {Study Group}",
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T1 - Significance of computed tomography and serum potassium in predicting subtype diagnosis of primary aldosteronism

AU - Umakoshi, Hironobu

AU - Tsuiki, Mika

AU - Takeda, Yoshiyu

AU - Kurihara, Isao

AU - Itoh, Hiroshi

AU - Katabami, Takuyuki

AU - Ichijo, Takamasa

AU - Wada, Norio

AU - Yoshimoto, Takanobu

AU - Ogawa, Yoshihiro

AU - Kawashima, Junji

AU - Sone, Masakatsu

AU - Inagaki, Nobuya

AU - Takahashi, Katsutoshi

AU - Watanabe, Minemori

AU - Matsuda, Yuichi

AU - Kobayashi, Hiroki

AU - Shibata, Hirotaka

AU - Kamemura, Kohei

AU - Otsuki, Michio

AU - Fujii, Yuichi

AU - Yamamto, Koichi

AU - Ogo, Atsushi

AU - Yanase, Toshihiko

AU - Suzuki, Tomoko

AU - Naruse, Mitsuhide

AU - JPAS Study Group, Study Group

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Context: The number of centers with established adrenal venous sampling (AVS) programs for the subtype diagnosis of primary aldosteronism (PA) is limited. Objective: Aim was to develop an algorithm for AVS based on subtype prediction by computed tomography (CT) and serum potassium. Design: A multi-institutional retrospective cohort study in Japan. Patients: A total of 1591 patients with PA were classified into four groups according to CT findings and potassium status. Subtype diagnosis of PA was determined by AVS. Main Outcome Measure: Prediction value of the combination of CT findings and potassium status for subtype diagnosis. Results: The percentages of unilateral hyperaldosteronism on AVS were higher in patients with unilateral disease on CT than those with bilateral normal results on CT (50.8% vs 14.6%, P, 0.01), and these percentages were higher in those with hypokalemia than those with normokalemia (58.4% vs 11.5%, P, 0.01). The prevalence and odds ratio for unilateral hyperaldosteronism on AVS were as follows: bilateral normal on CT with normokalemia, 6.2% (reference); unilateral disease on CT with normokalemia, 23.8% and 4.8 [95% confidence interval (CI), 3.1 to 7.2]; bilateral normal on CT with hypokalemia, 38.1% and 9.4 (95% CI, 6.2 to 14.1), and unilateral disease on CT with hypokalemia, 70.6% and 36.4 (95% CI, 24.7 to 53.5). Conclusions: Patients with PA with bilateral normal results on CT and normokalemia likely have a low prior probability of a lateralized form of AVS and could be treated medically, whereas those with unilateral disease on CT and hypokalemia have a high probability of a lateralized form of AVS.

AB - Context: The number of centers with established adrenal venous sampling (AVS) programs for the subtype diagnosis of primary aldosteronism (PA) is limited. Objective: Aim was to develop an algorithm for AVS based on subtype prediction by computed tomography (CT) and serum potassium. Design: A multi-institutional retrospective cohort study in Japan. Patients: A total of 1591 patients with PA were classified into four groups according to CT findings and potassium status. Subtype diagnosis of PA was determined by AVS. Main Outcome Measure: Prediction value of the combination of CT findings and potassium status for subtype diagnosis. Results: The percentages of unilateral hyperaldosteronism on AVS were higher in patients with unilateral disease on CT than those with bilateral normal results on CT (50.8% vs 14.6%, P, 0.01), and these percentages were higher in those with hypokalemia than those with normokalemia (58.4% vs 11.5%, P, 0.01). The prevalence and odds ratio for unilateral hyperaldosteronism on AVS were as follows: bilateral normal on CT with normokalemia, 6.2% (reference); unilateral disease on CT with normokalemia, 23.8% and 4.8 [95% confidence interval (CI), 3.1 to 7.2]; bilateral normal on CT with hypokalemia, 38.1% and 9.4 (95% CI, 6.2 to 14.1), and unilateral disease on CT with hypokalemia, 70.6% and 36.4 (95% CI, 24.7 to 53.5). Conclusions: Patients with PA with bilateral normal results on CT and normokalemia likely have a low prior probability of a lateralized form of AVS and could be treated medically, whereas those with unilateral disease on CT and hypokalemia have a high probability of a lateralized form of AVS.

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