Academic Journal
Optimizing adrenal vein sampling interpretation for primary aldosteronism subtyping.
| Τίτλος: | Optimizing adrenal vein sampling interpretation for primary aldosteronism subtyping. |
|---|---|
| Συγγραφείς: | Xiong Y; Department of Endocrinology, Sichuan-Chongqing Joint Key Laboratory of Metabolic Vascular Diseases, Chongqing Key Laboratory of Translational Medicine in Major Metabolic Diseases, The First Affiliated Hospital of Chongqing Medical University, No.1 Youyi Road, Yuzhong District, Chongqing, 400016, China., Luo S; Department of Urology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China., Peng S; Department of Endocrinology, Sichuan-Chongqing Joint Key Laboratory of Metabolic Vascular Diseases, Chongqing Key Laboratory of Translational Medicine in Major Metabolic Diseases, The First Affiliated Hospital of Chongqing Medical University, No.1 Youyi Road, Yuzhong District, Chongqing, 400016, China., Jing Y; Department of Endocrinology, Sichuan-Chongqing Joint Key Laboratory of Metabolic Vascular Diseases, Chongqing Key Laboratory of Translational Medicine in Major Metabolic Diseases, The First Affiliated Hospital of Chongqing Medical University, No.1 Youyi Road, Yuzhong District, Chongqing, 400016, China., Shen H; Department of Endocrinology, Sichuan-Chongqing Joint Key Laboratory of Metabolic Vascular Diseases, Chongqing Key Laboratory of Translational Medicine in Major Metabolic Diseases, The First Affiliated Hospital of Chongqing Medical University, No.1 Youyi Road, Yuzhong District, Chongqing, 400016, China., Zhang X; Department of Endocrinology, Sichuan-Chongqing Joint Key Laboratory of Metabolic Vascular Diseases, Chongqing Key Laboratory of Translational Medicine in Major Metabolic Diseases, The First Affiliated Hospital of Chongqing Medical University, No.1 Youyi Road, Yuzhong District, Chongqing, 400016, China., Zeng Q; Department of Endocrinology, Sichuan-Chongqing Joint Key Laboratory of Metabolic Vascular Diseases, Chongqing Key Laboratory of Translational Medicine in Major Metabolic Diseases, The First Affiliated Hospital of Chongqing Medical University, No.1 Youyi Road, Yuzhong District, Chongqing, 400016, China., Song Y; Department of Endocrinology, Sichuan-Chongqing Joint Key Laboratory of Metabolic Vascular Diseases, Chongqing Key Laboratory of Translational Medicine in Major Metabolic Diseases, The First Affiliated Hospital of Chongqing Medical University, No.1 Youyi Road, Yuzhong District, Chongqing, 400016, China., Zhen Q; Department of Endocrinology, Sichuan-Chongqing Joint Key Laboratory of Metabolic Vascular Diseases, Chongqing Key Laboratory of Translational Medicine in Major Metabolic Diseases, The First Affiliated Hospital of Chongqing Medical University, No.1 Youyi Road, Yuzhong District, Chongqing, 400016, China., He Y; Department of Endocrinology, Sichuan-Chongqing Joint Key Laboratory of Metabolic Vascular Diseases, Chongqing Key Laboratory of Translational Medicine in Major Metabolic Diseases, The First Affiliated Hospital of Chongqing Medical University, No.1 Youyi Road, Yuzhong District, Chongqing, 400016, China., He W; Department of Endocrinology, Sichuan-Chongqing Joint Key Laboratory of Metabolic Vascular Diseases, Chongqing Key Laboratory of Translational Medicine in Major Metabolic Diseases, The First Affiliated Hospital of Chongqing Medical University, No.1 Youyi Road, Yuzhong District, Chongqing, 400016, China., Zhang Q; Department of Endocrinology, Sichuan-Chongqing Joint Key Laboratory of Metabolic Vascular Diseases, Chongqing Key Laboratory of Translational Medicine in Major Metabolic Diseases, The First Affiliated Hospital of Chongqing Medical University, No.1 Youyi Road, Yuzhong District, Chongqing, 400016, China., Hu J; Department of Endocrinology, Sichuan-Chongqing Joint Key Laboratory of Metabolic Vascular Diseases, Chongqing Key Laboratory of Translational Medicine in Major Metabolic Diseases, The First Affiliated Hospital of Chongqing Medical University, No.1 Youyi Road, Yuzhong District, Chongqing, 400016, China., Ma L; Department of Endocrinology, Sichuan-Chongqing Joint Key Laboratory of Metabolic Vascular Diseases, Chongqing Key Laboratory of Translational Medicine in Major Metabolic Diseases, The First Affiliated Hospital of Chongqing Medical University, No.1 Youyi Road, Yuzhong District, Chongqing, 400016, China., Li Q; Department of Endocrinology, Sichuan-Chongqing Joint Key Laboratory of Metabolic Vascular Diseases, Chongqing Key Laboratory of Translational Medicine in Major Metabolic Diseases, The First Affiliated Hospital of Chongqing Medical University, No.1 Youyi Road, Yuzhong District, Chongqing, 400016, China., Yang S; Department of Endocrinology, Sichuan-Chongqing Joint Key Laboratory of Metabolic Vascular Diseases, Chongqing Key Laboratory of Translational Medicine in Major Metabolic Diseases, The First Affiliated Hospital of Chongqing Medical University, No.1 Youyi Road, Yuzhong District, Chongqing, 400016, China. 203737@hospital.cqmu.edu.cn. |
| Συλλογικό Έργο: | Chongqing Primary Aldosteronism Study (CONPASS) Group |
| Πηγή: | Endocrine [Endocrine] 2026 Oct 06; Vol. 91 (1). Date of Electronic Publication: 2026 Oct 06. |
| Τύπος έκδοσης: | Journal Article |
| Γλώσσα: | English |
| Στοιχεία περιοδικού: | Publisher: Humana Press Country of Publication: United States NLM ID: 9434444 Publication Model: Electronic Cited Medium: Internet ISSN: 1559-0100 (Electronic) Linking ISSN: 1355008X NLM ISO Abbreviation: Endocrine Subsets: MEDLINE |
| Imprint Name(s): | Publication: Feb. 1996- : Totowa, NJ : Humana Press Original Publication: Houndsmills, Basingstoke, Hants, UK : Macmillan Press, c1994- |
| Ιατρικοί όροι (MeSH): | Hyperaldosteronism*/blood , Hyperaldosteronism*/diagnosis , Hyperaldosteronism*/classification , Adrenal Glands*/blood supply , Blood Specimen Collection*/methods, Aldosterone/blood ; Hydrocortisone/blood ; Humans ; Female ; Retrospective Studies ; Male ; Middle Aged ; Veins ; Adult ; Aged |
| Περίληψη: | Context: Guidelines recommend adrenal vein sampling (AVS) for subtyping primary aldosteronism (PA); however, the optimal sample for determining lateralization when multiple successful adrenal vein samples are obtained is unclear. Objective: To compare the impact of different adrenal vein sample-selection strategies on PA subtyping. Methods: A retrospective study was conducted in PA patients who underwent bilaterally successful AVS with multiple samples obtained from each adrenal vein. LI was calculated using four different sample-selection strategies: (1) Maximum Aldosterone (Max Aldo), the sample with the highest aldosterone concentration; (2) Maximum Cortisol (Max Cort), the sample with the highest cortisol concentration; (3) Maximum ACR (Max ACR), the sample with the highest aldosterone-to-cortisol ratio (ACR) across samples; (4) Mean ACR, the average ACR of all samples. The theoretical detection rate of unilateral PA (UPA) and diagnostic accuracy for PA subtyping were compared among the four strategies. Results: A total of 585 patients with PA were included. In the 460 PA patients who underwent non-adrenocorticotropic hormone (ACTH)-stimulated AVS, the theoretical detection rate of UPA varied significantly among the four sample-selection strategies (P < 0.001), and was highest with Max Aldo (62.0%, 285/460), followed by Max ACR (59.1%, 272/460), Max Cort (57.8%, 266/460) and Mean ACR (56.3%, 259/460). Among 206 patients with postoperative diagnoses, the accuracy also differed significantly among the four strategies (P < 0.001), and Max Aldo ranked first (85.9%, 95% CI: 80.6%-90.1%), followed by Max ACR (84.0%, 95% CI: 78.4%-88.5%), Mean ACR (82.0%, 95% CI: 76.3%-86.8%), and Max Cort (78.2%, 95% CI: 72.0%-83.4%). Max Aldo was more accurate than Max Cort (adjusted P < 0.001), whereas no significant differences were observed between Max Aldo and Max ACR or Mean ACR (all adjusted P > 0.05). In the 308 patients who underwent ACTH-stimulated AVS, Max Aldo yielded the highest numerical detection rate and diagnostic accuracy; however, no significant differences were observed among the four strategies (P = 0.078 for theoretical UPA detection and P = 0.098 for diagnostic accuracy). Conclusion: For AVS with multiple samples, calculation of the LI based on the sample with the highest aldosterone concentration on each side tended to yield the highest numerical theoretical detection rate of UPA and accuracy, particularly in non-ACTH-stimulated AVS protocols. (© 2026. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.) |
| Competing Interests: | Declarations. Ethics approval: The Ethics Committee of the First Affiliated Hospital of Chongqing Medical University approved the protocol (Approval No. [2025-493-01]). Informed written consent was obtained from each participant. Competing interests: The authors declare no competing interests. |
| References: | J Clin Endocrinol Metab. 2025 Aug 07;110(9):2453-2495. (PMID: 40658480) Hypertension. 2009 May;53(5):761-6. (PMID: 19349554) Hypertension. 2018 Jan;71(1):118-124. (PMID: 29158354) Hypertension. 2015 Apr;65(4):849-54. (PMID: 25646291) Eur J Endocrinol. 2020 Mar;182(3):265-273. (PMID: 32038030) J Clin Endocrinol Metab. 1995 Jan;80(1):28-33. (PMID: 7829626) Endocr Rev. 2025 Jul 15;46(4):501-517. (PMID: 39965116) Am J Physiol. 1992 May;262(5 Pt 2):F871-7. (PMID: 1590429) World J Surg. 2020 Feb;44(2):561-569. (PMID: 31720794) Lancet Diabetes Endocrinol. 2021 Dec;9(12):876-892. (PMID: 34798068) Eur Heart J. 2014 May 14;35(19):1245-54. (PMID: 24366917) J Am Coll Cardiol. 2020 Apr 28;75(16):1913-1922. (PMID: 32327102) Lancet Diabetes Endocrinol. 2017 Sep;5(9):689-699. (PMID: 28576687) N Engl J Med. 1994 Jul 28;331(4):250-8. (PMID: 8015573) J Am Coll Cardiol. 2017 Apr 11;69(14):1811-1820. (PMID: 28385310) Am J Hypertens. 2021 Feb 18;34(1):34-45. (PMID: 33179734) J Clin Endocrinol Metab. 2023 Apr 13;108(5):1143-1153. (PMID: 36413507) J Hypertens. 2019 May;37(5):1077-1082. (PMID: 30601318) Ann Intern Med. 2022 Oct;175(10):1383-1391. (PMID: 36095315) Lancet Diabetes Endocrinol. 2018 Jan;6(1):41-50. (PMID: 29129575) J Clin Endocrinol Metab. 2016 May;101(5):1889-916. (PMID: 26934393) Ann Intern Med. 2020 Jul 7;173(1):10-20. (PMID: 32449886) Radiology. 2025 Apr;315(1):e240631. (PMID: 40232138) J Hypertens. 2020 Oct;38(10):1919-1928. (PMID: 32890264) Lancet Diabetes Endocrinol. 2018 Jan;6(1):51-59. (PMID: 29129576) Eur J Endocrinol. 2010 Jan;162(1):101-7. (PMID: 19605541) Hypertension. 2014 Jan;63(1):151-60. (PMID: 24218436) Langenbecks Arch Surg. 2010 Feb;395(2):133-7. (PMID: 19418066) Curr Opin Endocrinol Diabetes Obes. 2016 Jun;23(3):218-24. (PMID: 27119749) J Clin Endocrinol Metab. 2022 Dec 17;108(1):33-41. (PMID: 36179243) JAMA Netw Open. 2023 Oct 2;6(10):e2338209. (PMID: 37870836) Int J Mol Sci. 2023 Dec 14;24(24):. (PMID: 38139285) Lancet Diabetes Endocrinol. 2015 Apr;3(4):296-303. (PMID: 24831990) JAMA Netw Open. 2023 Feb 1;6(2):e2255609. (PMID: 36795418) Hypertension. 2021 Mar 3;77(3):891-899. (PMID: 33280409) Endocr Pract. 2021 Apr;27(4):326-333. (PMID: 33779561) |
| Grant Information: | 82500961 National Natural Science Foundation of China; 2025MD784154 China Postdoctoral Science Foundation; 2024CQBSHTB2027 Chongqing Postdoctoral Science Foundation; CSTB2023NSCQ-JQX0028 Science Fund for Distinguished Young Scholars of Chongqing Municipality; KJZD-K202500409 Chongqing Municipal Education Commission; CSTB2024TIAD-KPX0039 Chongqing Municipal Science and Technology Bureau; CSTB2025TIAD-KPX0098 Chongqing Municipal Science and Technology Bureau |
| Contributed Indexing: | Keywords: Adrenal vein sampling; Lateralization index; Primary aldosteronism; Subtyping |
| Substance Nomenclature: | 4964P6T9RB (Aldosterone) WI4X0X7BPJ (Hydrocortisone) |
| Entry Date(s): | Date Created: 20261006 Date Completed: 20261006 Latest Revision: 20261010 |
| Update Code: | 20261010 |
| DOI: | 10.1007/s12020-026-04806-1 |
| PMID: | 42836924 |
| Βάση Δεδομένων: | MEDLINE |
| ISSN: | 1559-0100 |
|---|---|
| DOI: | 10.1007/s12020-026-04806-1 |