Data from: Aldosterone reduction rate after saline infusion may be a novel clinical prediction of determining subtypes of primary aldosteronism

ObjectiveAccurate assessment of the localization of aldosterone-producing
adenomas (APAs) is essential for the treatment of primary aldosteronism
(PA). Although adrenal venous sampling (AVS) is the standard method of
reference for subtype diagnosis in PA, controversy exists concerning the
criteria for interpretation. This study aimed to determine better
indicators that can reliably predict subtypes of PA. 
MethodRetrospective analysis in single-cohort including 209 patients with
PA who were subjected to AVS. 82 patients whose plasma aldosterone
concentrations (PAC) were normalized after surgery were
histopathologically or genetically diagnosed with APA. The accuracy of
image findings was compared to AVS results. Receiver operating
characteristic (ROC) curve analysis between the operated and no apparent
laterality groups was performed using AVS parameters and loading test for
diagnosis of PA.  Result The agreement between image
findings and AVS results was 56.3%. ROC curve analysis revealed that
lateralization index (LI) after ACTH stimulation cutoff value was 2.40,
with 98.8% sensitivity and 97.1% specificity. The contralateral
suppression index (CSI) cutoff value was 1.19, with 98.0% sensitivity and
93.9% specificity. All patients over the LI and CSI cutoff values
exhibited unilateral subtypes. Among the loading test, the best
classification accuracy was achieved using the PAC reduction rate
after saline infusiontest (SIT) >33.8%, which yielded 87.2%
sensitivity or PAC after SIT <87.9 pg/mL 86.2% specificity for
predicting bilateral PA.  ConclusionThe combined criterion of the
PAC reduction rate and PAC after SIT may determine a subset of patients
with APA who should be performed AVS for validation.