EYES2023 ESE Young Endocrinologists and Scientists (EYES) 2023 Oral communication 1: Adrenal Diseases (8 abstracts)
Clinical prediction model for primary aldosteronism subtyping and special focus on adrenal volumetric assessment: A pilot study
Tugba Barlas 1 , Erhan llgit 2 , Koray Akkan 3 , Emetullah Cindil 2 , Isil Gultekin 2 , Hulya Sodan 4 , Muhittin Yalcin 4 , Turgay Cerit 4 , Sinan Sozen 5 , Mujde Akturk 4 , Fusun Toruner 4 , Ayhan Karakoc 4 & Alev Eroglu Altinova 6
1Gazi University Faculty of Medicine, Endocrinology and Metabolism, Ankara, Turkey; 2Gazi University Faculty of Medicine, Radiology, Turkey; 3Gazi University, Radiology, Ankara, Turkey; 4Gazi University Faculty of Medicine, Endocrinology and Metabolism, Turkey; 5Gazi University Faculty of Medicine, Urology, Turkey; 6Gazi University Faculty of Medicine, Endocrinology and Metabolism.
Background: Adrenal venous sampling (AVS) is the gold standard diagnostic approach for differentiating unilateral from bilateral primary aldosteronism (PA). However, it is a costly, invasive, and operator-dependent procedure with restricted availability.
Objectives: It was aimed to develop a prediction model based on a simple clinical score with prominent parameters from the current literature for the subtype diagnosis of PA. The contribution of adrenal volumetric assessment to PA subtyping was also investigated.
Methods: Thirty-five patients with adequate cannulation in AVS were included. Laboratory data, saline infusion test (SIT), and AVS results of patients with PA were retrospectively evaluated. Volumetric assessment was performed using a magnetic resonance imaging, and the ratio of adrenal volumes was calculated after adjusting for gender- and side-specific mean reference values.
Results: The AVS was consistent with unilateral in 49% and bilateral in 51% of the patients. Hypertension as reason for work-up, highest aldosterone/lowest potassium value >12, the percentage of plasma aldosterone concentration reduction after SIT <43.5%, oral potassium replacement, unilateral disease at pre-AVS imaging, ratio of adjusted adrenal volumes <1.7 pointed to unilateral disease in univariate logistic regression analysis (P<0.05). Multivariate logistic regression analysis revealed that adrenal volumetric assessment has an impact on PA subtyping (P<0.05). In the prediction model, when each of the six parameters that were significant in the logistic regression analysis was given one point, <4 predicted bilateral, whereas ≥4 predicted unilateral PA (sensitivity 82%, specificity 84%, AUC:0.92, P<0.001).
Conclusions: PA subtyping is essential since it changes the therapeutic approach. This pre-AVS prediction model can be a convenient and practical method, and an adjusted adrenal volumetric assessment can make a positive contribution to PA subtyping.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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