5.6 Assessment of the Selectivity and Lateralisation Index for Adrenal Vein Sampling in Primary Aldosteronism
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High Blood Press Cardiovasc Prev 2007; 14 (3): 145-196 1120-9879/07/0003-0145/$44.95/0 © 2007 Adis Data Information BV. All rights reserved.
Hormonal Mechanisms 5.6 Assessment of the Selectivity and Lateralisation Index for Adrenal Vein Sampling in Primary Aldosteronism G. Pitter,1 D. Montemurro,1 P. Bernante,2 D. Miotto,3 A.C. Pessina,1 G.P. Rossi1 (1) Department of Clinical and Experimental Medicine, Pa Padova; (2) Department of Medical and Surgical Sciences, Pa Padova; (3) Institute of Radiology, Padova, It Italy Introduction: Adrenal vein sampling (AVS) is crucial for identifying the primary aldosteronism (PA) subtypes, but the cut-off values for ascertaining selectivity of catheterisation and lateralisation of aldosterone secretion remain controversial. The aims of our study were: 1) to evaluate the cut-off values for the Selectivity (SI) and Lateralisation Index (LI) in patients with aldosterone-producing adenoma (APA); 2) to examine the effect of ACTH stimulation on SI and LI performance. Methods: We assessed the proportion of selective AVS at different SI cut-off values in 150 consecutive patients with PA undergoing bilaterally simultaneous AVS. APA diagnosis required: 1) biochemical evidence of PA; 2) lateralisation of aldosterone secretion; 3) adenoma at pathology, and 4) normocalaemia + correction of PA + cure or improvement of hypertension at follow-up. In 39 patients with bilaterally selective AVS and APA by these criteria we examined different cut-off values of LI for assessing the lateralisation of aldosterone excess and the usefulness of ACTH stimulation (250 μg i.v. bolus) in improving SI and LI during AVS. Results: Bilaterally selective AVS decreased steadily (from 79.2% to 39.6%) by increasing SI cut-offs from 1.1 to 5.0. Likewise, correctly identified APAs fell (from 97.4% to 43.6%) by increasing LI cutoffs from 1.125 to 5.0. ACTH improved the assessment of selectivity, but exerted a confounding effect on LI. Conclusions: 1) Increasing the SI cut-offs lowers the number of usable AVS. 2) Higher LI cut-off values lead to overlooking of a proportion of APAs. 3) The improved selectivity with ACTH stimulation should be weighed against the loss of correct lateralisation.
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