Treatment decision based on unilateral index from nonadrenocorticotropic hormone-stimulated and adrenocorticotropic hormone-stimulated adrenal vein sampling in primary aldosteronism

作者全名："Zhang, Xizi; Shu, Xiaoyu; Wu, Feifei; Yang, Jun; Cheng, Qingfeng; Du, Zhipeng; Song, Ying; Yang, Yi; Hu, Jinbo; Wang, Yue; Li, Qifu; Yang, Shumin"

作者地址："[Zhang, Xizi; Cheng, Qingfeng; Du, Zhipeng; Song, Ying; Yang, Yi; Hu, Jinbo; Wang, Yue; Li, Qifu; Yang, Shumin] Chongqing Med Univ, Affiliated Hosp 1, Dept Endocrinol, Chongqing, Peoples R China; [Shu, Xiaoyu] Capital Med Univ, Beijing Chao Yang Hosp, Dept Endocrinol, Beijing, Peoples R China; [Wu, Feifei] Changzhi Med Coll, Heping Hosp, Dept Endocrinol, Changzhi, Peoples R China; [Yang, Jun] Monash Univ, Dept Med, Clayton, Vic, Australia; [Yang, Jun] Hudson Inst Med Res, Ctr Endocrinol & Metab, Clayton, Vic, Australia"

通信作者："Yang, SM (通讯作者)，Chongqing Med Univ, Affiliated Hosp 1, 1 Youyi St, Chongqing 400016, Peoples R China."

来源：JOURNAL OF HYPERTENSION

ESI学科分类：CLINICAL MEDICINE

WOS号：WOS:001153954000020

JCR分区：Q1

影响因子：3.3

年份：2024

卷号：42

期号：3

开始页：450

结束页：459

文献类型：Article

关键词：adrenal vein/inferior vena cava index; adrenal venous sampling; contralateral disease; ipsilateral disease; primary aldosteronism; unilateral index

摘要："Objective:Adrenal venous sampling (AVS) is recommended for identifying the subtype of primary aldosteronism before making a surgical treatment decision, but failed cannulation of one adrenal vein is common. To evaluate whether using results of one adrenal vein during AVS could accurately predict unilateral primary aldosteronism.A retrospective study was conducted in primary aldosteronism patients receiving bilaterally or unilaterally successful AVS. The aldosterone-cortisol ratio from the adrenal vein divided by the aldosterone-cortisol ratio from the inferior vena cava (IVC) was calculated as the AV/IVC index.The study examined 455 patients with primary aldosteronism, including 347 patients with unilateral primary aldosteronism. Among them, 250 and 125 patients received non- adrenocorticotropic hormone (ACTH) and ACTH-stimulated AVS, respectively, and 80 patients received both forms of AVS. Under non-ACTH-stimulated AVS, AUC of the AV/IVC index to diagnose ipsilateral and contralateral primary aldosteronism were 0.778 and 0.924, respectively. The specificity was 100% for both, with sensitivities of 5 and 26%, respectively, when using cutoffs of 17.05 to diagnose ipsilateral primary aldosteronism and 0.15 to diagnose contralateral primary aldosteronism. When using cutoffs of 3.60 and 0.70, the specificity decreased, but if combined with CT results (ipsilateral or contralateral adrenal nodules larger than 10 mm), the specificity could be maintained at 99%, with sensitivities of 33 and 45%, respectively. Under ACTH-stimulated AVS, the AV/IVC index showed similar accuracy to diagnose ipsilateral and contralateral primary aldosteronism.The unilateral AV/IVC index can be used to diagnose unilateral primary aldosteronism during AVS. Combining CT results can increase the accuracy further.Primary aldosteronism is one of the most common causes of secondary hypertension, accounting for 4-14% of all hypertensive patients [1-4]. In this condition, autonomous secretion of aldosterone from one or both adrenal glands lead to inappropriate sodium retention, volume expansion, hypertension, and mineralocorticoid receptor-mediated cardiovascular injury [5]. Accurately differentiating unilateral from bilateral adrenal disease is crucial for patients with primary aldosteronism, as surgical intervention is recommended for unilateral primary aldosteronism (UPA) whereas bilateral primary aldosteronism (BPA) is typically treated with oral mineralocorticoid receptor antagonists such as spironolactone [6-8].The current subtyping methods mainly include adrenal computed tomography (CT) and adrenal vein sampling (AVS). As the accuracy of CT is only 52-81% [9-13], AVS is generally recommended to distinguish between UPA and BPA [14-17]. At present, lateralization of aldosterone excess is determined by the lateralization index, which is calculated from the aldosterone-cortisol ratio of one adrenal vein compared with the other following the successful cannulation of both adrenal veins [18]. However, AVS is a technically demanding procedure, with reported bilateral cannulation success rates of 21-95.6% [13,19-22]. Therefore, in the case of successful cannulation of just one adrenal vein, the lateralization index cannot be calculated and lateralization cannot be determined definitively. Several studies have suggested that, in the event of failed cannulation of one adrenal veins, the unilateral index, namely the aldosterone-cortisol ratio of the adrenal vein divided by the same ratio in the inferior vena cava (IVC), can distinguish between unilateral and bilateral primary aldosteronism [23-32]. Most studies have reported the unilateral AV/IVC index using ACTH-stimulated AVS [24-30,32]. One study reported the index based on non-ACTH stimulated AVS [23], which is common practice in many centres. Recently, Rossi et al.[31] reported the index based on AVS results with or without ACTH. However, the diagnostic performance and optimal cutoffs of the unilateral AV/IVC index vary among studies. Our study aims to determine the diagnostic performance and the optimal cutoffs of the unilateral AV/IVC index during non-ACTH-stimulated or ACTH-stimulated AVS for predicting unilateral aldosterone secretion. The cutoffs reported previously were also tested in our cohorts.Objective:Adrenal venous sampling (AVS) is recommended for identifying the subtype of primary aldosteronism before making a surgical treatment decision, but failed cannulation of one adrenal vein is common. To evaluate whether using results of one adrenal vein during AVS could accurately predict unilateral primary aldosteronism.A retrospective study was conducted in primary aldosteronism patients receiving bilaterally or unilaterally successful AVS. The aldosterone-cortisol ratio from the adrenal vein divided by the aldosterone-cortisol ratio from the inferior vena cava (IVC) was calculated as the AV/IVC index.The study examined 455 patients with primary aldosteronism, including 347 patients with unilateral primary aldosteronism. Among them, 250 and 125 patients received non- adrenocorticotropic hormone (ACTH) and ACTH-stimulated AVS, respectively, and 80 patients received both forms of AVS. Under non-ACTH-stimulated AVS, AUC of the AV/IVC index to diagnose ipsilateral and contralateral primary aldosteronism were 0.778 and 0.924, respectively. The specificity was 100% for both, with sensitivities of 5 and 26%, respectively, when using cutoffs of 17.05 to diagnose ipsilateral primary aldosteronism and 0.15 to diagnose contralateral primary aldosteronism. When using cutoffs of 3.60 and 0.70, the specificity decreased, but if combined with CT results (ipsilateral or contralateral adrenal nodules larger than 10 mm), the specificity could be maintained at 99%, with sensitivities of 33 and 45%, respectively. Under ACTH-stimulated AVS, the AV/IVC index showed similar accuracy to diagnose ipsilateral and contralateral primary aldosteronism.The unilateral AV/IVC index can be used to diagnose unilateral primary aldosteronism during AVS. Combining CT results can increase the accuracy further.Primary aldosteronism is one of the most common causes of secondary hypertension, accounting for 4-14% of all hypertensive patients [1-4]. In this condition, autonomous secretion of aldosterone from one or both adrenal glands lead to inappropriate sodium retention, volume expansion, hypertension, and mineralocorticoid receptor-mediated cardiovascular injury [5]. Accurately differentiating unilateral from bilateral adrenal disease is crucial for patients with primary aldosteronism, as surgical intervention is recommended for unilateral primary aldosteronism (UPA) whereas bilateral primary aldosteronism (BPA) is typically treated with oral mineralocorticoid receptor antagonists such as spironolactone [6-8]. The current subtyping methods mainly include adrenal computed tomography (CT) and adrenal vein sampling (AVS). As the accuracy of CT is only 52-81% [9-13], AVS is generally recommended to distinguish between UPA and BPA [14-17]. At present, lateralization of aldosterone excess is determined by the lateralization index, which is calculated from the aldosterone-cortisol ratio of one adrenal vein compared with the other following the successful cannulation of both adrenal veins [18]. However, AVS is a technically demanding procedure, with reported bilateral cannulation success rates of 21-95.6% [13,19-22]. Therefore, in the case of successful cannulation of just one adrenal vein, the lateralization index cannot be calculated and lateralization cannot be determined definitively.Several studies have suggested that, in the event of failed cannulation of one adrenal veins, the unilateral index, namely the aldosterone-cortisol ratio of the adrenal vein divided by the same ratio in the inferior vena cava (IVC), can distinguish between unilateral and bilateral primary aldosteronism [23-32]. Most studies have reported the unilateral AV/IVC index using ACTH-stimulated AVS [24-30,32]. One study reported the index based on non-ACTH stimulated AVS [23], which is common practice in many centres. Recently, Rossi et al.[31] reported the index based on AVS results with or without ACTH. However, the diagnostic performance and optimal cutoffs of the unilateral AV/IVC index vary among studies. Our study aims to determine the diagnostic performance and the optimal cutoffs of the unilateral AV/IVC index during non-ACTH-stimulated or ACTH-stimulated AVS for predicting unilateral aldosterone secretion. The cutoffs reported previously were also tested in our cohorts.Objective:Adrenal venous sampling (AVS) is recommended for identifying the subtype of primary aldosteronism before making a surgical treatment decision, but failed cannulation of one adrenal vein is common. To evaluate whether using results of one adrenal vein during AVS could accurately predict unilateral primary aldosteronism.A retrospective study was conducted in primary aldosteronism patients receiving bilaterally or unilaterally successful AVS. The aldosterone-cortisol ratio from the adrenal vein divided by the aldosterone-cortisol ratio from the inferior vena cava (IVC) was calculated as the AV/IVC index.The study examined 455 patients with primary aldosteronism, including 347 patients with unilateral primary aldosteronism. Among them, 250 and 125 patients received non- adrenocorticotropic hormone (ACTH) and ACTH-stimulated AVS, respectively, and 80 patients received both forms of AVS. Under non-ACTH-stimulated AVS, AUC of the AV/IVC index to diagnose ipsilateral and contralateral primary aldosteronism were 0.778 and 0.924, respectively. The specificity was 100% for both, with sensitivities of 5 and 26%, respectively, when using cutoffs of 17.05 to diagnose ipsilateral primary aldosteronism and 0.15 to diagnose contralateral primary aldosteronism. When using cutoffs of 3.60 and 0.70, the specificity decreased, but if combined with CT results (ipsilateral or contralateral adrenal nodules larger than 10 mm), the specificity could be maintained at 99%, with sensitivities of 33 and 45%, respectively. Under ACTH-stimulated AVS, the AV/IVC index showed similar accuracy to diagnose ipsilateral and contralateral primary aldosteronism.The unilateral AV/IVC index can be used to diagnose unilateral primary aldosteronism during AVS. Combining CT results can increase the accuracy further. Primary aldosteronism is one of the most common causes of secondary hypertension, accounting for 4-14% of all hypertensive patients [1-4]. In this condition, autonomous secretion of aldosterone from one or both adrenal glands lead to inappropriate sodium retention, volume expansion, hypertension, and mineralocorticoid receptor-mediated cardiovascular injury [5]. Accurately differentiating unilateral from bilateral adrenal disease is crucial for patients with primary aldosteronism, as surgical intervention is recommended for unilateral primary aldosteronism (UPA) whereas bilateral primary aldosteronism (BPA) is typically treated with oral mineralocorticoid receptor antagonists such as spironolactone [6-8].The current subtyping methods mainly include adrenal computed tomography (CT) and adrenal vein sampling (AVS). As the accuracy of CT is only 52-81% [9-13], AVS is generally recommended to distinguish between UPA and BPA [14-17]. At present, lateralization of aldosterone excess is determined by the lateralization index, which is calculated from the aldosterone-cortisol ratio of one adrenal vein compared with the other following the successful cannulation of both adrenal veins [18]. However, AVS is a technically demanding procedure, with reported bilateral cannulation success rates of 21-95.6% [13,19-22]. Therefore, in the case of successful cannulation of just one adrenal vein, the lateralization index cannot be calculated and lateralization cannot be determined definitively.Several studies have suggested that, in the event of failed cannulation of one adrenal veins, the unilateral index, namely the aldosterone-cortisol ratio of the adrenal vein divided by the same ratio in the inferior vena cava (IVC), can distinguish between unilateral and bilateral primary aldosteronism [23-32]. Most studies have reported the unilateral AV/IVC index using ACTH-stimulated AVS [24-30,32]. One study reported the index based on non-ACTH stimulated AVS [23], which is common practice in many centres. Recently, Rossi et al.[31] reported the index based on AVS results with or without ACTH. However, the diagnostic performance and optimal cutoffs of the unilateral AV/IVC index vary among studies. Our study aims to determine the diagnostic performance and the optimal cutoffs of the unilateral AV/IVC index during non-ACTH-stimulated or ACTH-stimulated AVS for predicting unilateral aldosterone secretion. The cutoffs reported previously were also tested in our cohorts.Objective:Adrenal venous sampling (AVS) is recommended for identifying the subtype of primary aldosteronism before making a surgical treatment decision, but failed cannulation of one adrenal vein is common. To evaluate whether using results of one adrenal vein during AVS could accurately predict unilateral primary aldosteronism.A retrospective study was conducted in primary aldosteronism patients receiving bilaterally or unilaterally successful AVS. The aldosterone-cortisol ratio from the adrenal vein divided by the aldosterone-cortisol ratio from the inferior vena cava (IVC) was calculated as the AV/IVC index.The study examined 455 patients with primary aldosteronism, including 347 patients with unilateral primary aldosteronism. Among them, 250 and 125 patients received non- adrenocorticotropic hormone (ACTH) and ACTH-stimulated AVS, respectively, and 80 patients received both forms of AVS. Under non-ACTH-stimulated AVS, AUC of the AV/IVC index to diagnose ipsilateral and contralateral primary aldosteronism were 0.778 and 0.924, respectively. The specificity was 100% for both, with sensitivities of 5 and 26%, respectively, when using cutoffs of 17.05 to diagnose ipsilateral primary aldosteronism and 0.15 to diagnose contralateral primary aldosteronism. When using cutoffs of 3.60 and 0.70, the specificity decreased, but if combined with CT results (ipsilateral or contralateral adrenal nodules larger than 10 mm), the specificity could be maintained at 99%, with sensitivities of 33 and 45%, respectively. Under ACTH-stimulated AVS, the AV/IVC index showed similar accuracy to diagnose ipsilateral and contralateral primary aldosteronism.The unilateral AV/IVC index can be used to diagnose unilateral primary aldosteronism during AVS. Combining CT results can increase the accuracy further.Primary aldosteronism is one of the most common causes of secondary hypertension, accounting for 4-14% of all hypertensive patients [1-4]. In this condition, autonomous secretion of aldosterone from one or both adrenal glands lead to inappropriate sodium retention, volume expansion, hypertension, and mineralocorticoid receptor-mediated cardiovascular injury [5]. Accurately differentiating unilateral from bilateral adrenal disease is crucial for patients with primary aldosteronism, as surgical intervention is recommended for unilateral primary aldosteronism (UPA) whereas bilateral primary aldosteronism (BPA) is typically treated with oral mineralocorticoid receptor antagonists such as spironolactone [6-8].The current subtyping methods mainly include adrenal computed tomography (CT) and adrenal vein sampling (AVS). As the accuracy of CT is only 52-81% [9-13], AVS is generally recommended to distinguish between UPA and BPA [14-17]. At present, lateralization of aldosterone excess is determined by the lateralization index, which is calculated from the aldosterone-cortisol ratio of one adrenal vein compared with the other following the successful cannulation of both adrenal veins [18]. However, AVS is a technically demanding procedure, with reported bilateral cannulation success rates of 21-95.6% [13,19-22]. Therefore, in the case of successful cannulation of just one adrenal vein, the lateralization index cannot be calculated and lateralization cannot be determined definitively.Several studies have suggested that, in the event of failed cannulation of one adrenal veins, the unilateral index, namely the aldosterone-cortisol ratio of the adrenal vein divided by the same ratio in the inferior vena cava (IVC), can distinguish between unilateral and bilateral primary aldosteronism [23-32]. Most studies have reported the unilateral AV/IVC index using ACTH-stimulated AVS [24-30,32]. One study reported the index based on non-ACTH stimulated AVS [23], which is common practice in many centres. Recently, Rossi et al.[31] reported the index based on AVS results with or without ACTH. However, the diagnostic performance and optimal cutoffs of the unilateral AV/IVC index vary among studies. Our study aims to determine the diagnostic performance and the optimal cutoffs of the unilateral AV/IVC index during non-ACTH-stimulated or ACTH-stimulated AVS for predicting unilateral aldosterone secretion. The cutoffs reported previously were also tested in our cohorts.Objective:Adrenal venous sampling (AVS) is recommended for identifying the subtype of primary aldosteronism before making a surgical treatment decision, but failed cannulation of one adrenal vein is common. To evaluate whether using results of one adrenal vein during AVS could accurately predict unilateral primary aldosteronism. A retrospective study was conducted in primary aldosteronism patients receiving bilaterally or unilaterally successful AVS. The aldosterone-cortisol ratio from the adrenal vein divided by the aldosterone-cortisol ratio from the inferior vena cava (IVC) was calculated as the AV/IVC index.The study examined 455 patients with primary aldosteronism, including 347 patients with unilateral primary aldosteronism. Among them, 250 and 125 patients received non- adrenocorticotropic hormone (ACTH) and ACTH-stimulated AVS, respectively, and 80 patients received both forms of AVS. Under non-ACTH-stimulated AVS, AUC of the AV/IVC index to diagnose ipsilateral and contralateral primary aldosteronism were 0.778 and 0.924, respectively. The specificity was 100% for both, with sensitivities of 5 and 26%, respectively, when using cutoffs of 17.05 to diagnose ipsilateral primary aldosteronism and 0.15 to diagnose contralateral primary aldosteronism. When using cutoffs of 3.60 and 0.70, the specificity decreased, but if combined with CT results (ipsilateral or contralateral adrenal nodules larger than 10 mm), the specificity could be maintained at 99%, with sensitivities of 33 and 45%, respectively. Under ACTH-stimulated AVS, the AV/IVC index showed similar accuracy to diagnose ipsilateral and contralateral primary aldosteronism.The unilateral AV/IVC index can be used to diagnose unilateral primary aldosteronism during AVS. Combining CT results can increase the accuracy further.Primary aldosteronism is one of the most common causes of secondary hypertension, accounting for 4-14% of all hypertensive patients [1-4]. In this condition, autonomous secretion of aldosterone from one or both adrenal glands lead to inappropriate sodium retention, volume expansion, hypertension, and mineralocorticoid receptor-mediated cardiovascular injury [5]. Accurately differentiating unilateral from bilateral adrenal disease is crucial for patients with primary aldosteronism, as surgical intervention is recommended for unilateral primary aldosteronism (UPA) whereas bilateral primary aldosteronism (BPA) is typically treated with oral mineralocorticoid receptor antagonists such as spironolactone [6-8].The current subtyping methods mainly include adrenal computed tomography (CT) and adrenal vein sampling (AVS). As the accuracy of CT is only 52-81% [9-13], AVS is generally recommended to distinguish between UPA and BPA [14-17]. At present, lateralization of aldosterone excess is determined by the lateralization index, which is calculated from the aldosterone-cortisol ratio of one adrenal vein compared with the other following the successful cannulation of both adrenal veins [18]. However, AVS is a technically demanding procedure, with reported bilateral cannulation success rates of 21-95.6% [13,19-22]. Therefore, in the case of successful cannulation of just one adrenal vein, the lateralization index cannot be calculated and lateralization cannot be determined definitively.Several studies have suggested that, in the event of failed cannulation of one adrenal veins, the unilateral index, namely the aldosterone-cortisol ratio of the adrenal vein divided by the same ratio in the inferior vena cava (IVC), can distinguish between unilateral and bilateral primary aldosteronism [23-32]. Most studies have reported the unilateral AV/IVC index using ACTH-stimulated AVS [24-30,32]. One study reported the index based on non-ACTH stimulated AVS [23], which is common practice in many centres. Recently, Rossi et al.[31] reported the index based on AVS results with or without ACTH. However, the diagnostic performance and optimal cutoffs of the unilateral AV/IVC index vary among studies. Our study aims to determine the diagnostic performance and the optimal cutoffs of the unilateral AV/IVC index during non-ACTH-stimulated or ACTH-stimulated AVS for predicting unilateral aldosterone secretion. The cutoffs reported previously were also tested in our cohorts.Objective:Adrenal venous sampling (AVS) is recommended for identifying the subtype of primary aldosteronism before making a surgical treatment decision, but failed cannulation of one adrenal vein is common. To evaluate whether using results of one adrenal vein during AVS could accurately predict unilateral primary aldosteronism.A retrospective study was conducted in primary aldosteronism patients receiving bilaterally or unilaterally successful AVS. The aldosterone-cortisol ratio from the adrenal vein divided by the aldosterone-cortisol ratio from the inferior vena cava (IVC) was calculated as the AV/IVC index.The study examined 455 patients with primary aldosteronism, including 347 patients with unilateral primary aldosteronism. Among them, 250 and 125 patients received non- adrenocorticotropic hormone (ACTH) and ACTH-stimulated AVS, respectively, and 80 patients received both forms of AVS. Under non-ACTH-stimulated AVS, AUC of the AV/IVC index to diagnose ipsilateral and contralateral primary aldosteronism were 0.778 and 0.924, respectively. The specificity was 100% for both, with sensitivities of 5 and 26%, respectively, when using cutoffs of 17.05 to diagnose ipsilateral primary aldosteronism and 0.15 to diagnose contralateral primary aldosteronism. When using cutoffs of 3.60 and 0.70, the specificity decreased, but if combined with CT results (ipsilateral or contralateral adrenal nodules larger than 10 mm), the specificity could be maintained at 99%, with sensitivities of 33 and 45%, respectively. Under ACTH-stimulated AVS, the AV/IVC index showed similar accuracy to diagnose ipsilateral and contralateral primary aldosteronism.The unilateral AV/IVC index can be used to diagnose unilateral primary aldosteronism during AVS. Combining CT results can increase the accuracy further.Primary aldosteronism is one of the most common causes of secondary hypertension, accounting for 4-14% of all hypertensive patients [1-4]. In this condition, autonomous secretion of aldosterone from one or both adrenal glands lead to inappropriate sodium retention, volume expansion, hypertension, and mineralocorticoid receptor-mediated cardiovascular injury [5]. Accurately differentiating unilateral from bilateral adrenal disease is crucial for patients with primary aldosteronism, as surgical intervention is recommended for unilateral primary aldosteronism (UPA) whereas bilateral primary aldosteronism (BPA) is typically treated with oral mineralocorticoid receptor antagonists such as spironolactone [6-8].The current subtyping methods mainly include adrenal computed tomography (CT) and adrenal vein sampling (AVS). As the accuracy of CT is only 52-81% [9-13], AVS is generally recommended to distinguish between UPA and BPA [14-17]. At present, lateralization of aldosterone excess is determined by the lateralization index, which is calculated from the aldosterone-cortisol ratio of one adrenal vein compared with the other following the successful cannulation of both adrenal veins [18]. However, AVS is a technically demanding procedure, with reported bilateral cannulation success rates of 21-95.6% [13,19-22]. Therefore, in the case of successful cannulation of just one adrenal vein, the lateralization index cannot be calculated and lateralization cannot be determined definitively.Several studies have suggested that, in the event of failed cannulation of one adrenal veins, the unilateral index, namely the aldosterone-cortisol ratio of the adrenal vein divided by the same ratio in the inferior vena cava (IVC), can distinguish between unilateral and bilateral primary aldosteronism [23-32]. Most studies have reported the unilateral AV/IVC index using ACTH-stimulated AVS [24-30,32]. One study reported the index based on non-ACTH stimulated AVS [23], which is common practice in many centres. Recently, Rossi et al.[31] reported the index based on AVS results with or without ACTH. However, the diagnostic performance and optimal cutoffs of the unilateral AV/IVC index vary among studies. Our study aims to determine the diagnostic performance and the optimal cutoffs of the unilateral AV/IVC index during non-ACTH-stimulated or ACTH-stimulated AVS for predicting unilateral aldosterone secretion. The cutoffs reported previously were also tested in our cohorts.Objective:Adrenal venous sampling (AVS) is recommended for identifying the subtype of primary aldosteronism before making a surgical treatment decision, but failed cannulation of one adrenal vein is common. To evaluate whether using results of one adrenal vein during AVS could accurately predict unilateral primary aldosteronism.A retrospective study was conducted in primary aldosteronism patients receiving bilaterally or unilaterally successful AVS. The aldosterone-cortisol ratio from the adrenal vein divided by the aldosterone-cortisol ratio from the inferior vena cava (IVC) was calculated as the AV/IVC index.The study examined 455 patients with primary aldosteronism, including 347 patients with unilateral primary aldosteronism. Among them, 250 and 125 patients received non- adrenocorticotropic hormone (ACTH) and ACTH-stimulated AVS, respectively, and 80 patients received both forms of AVS. Under non-ACTH-stimulated AVS, AUC of the AV/IVC index to diagnose ipsilateral and contralateral primary aldosteronism were 0.778 and 0.924, respectively. The specificity was 100% for both, with sensitivities of 5 and 26%, respectively, when using cutoffs of 17.05 to diagnose ipsilateral primary aldosteronism and 0.15 to diagnose contralateral primary aldosteronism. When using cutoffs of 3.60 and 0.70, the specificity decreased, but if combined with CT results (ipsilateral or contralateral adrenal nodules larger than 10 mm), the specificity could be maintained at 99%, with sensitivities of 33 and 45%, respectively. Under ACTH-stimulated AVS, the AV/IVC index showed similar accuracy to diagnose ipsilateral and contralateral primary aldosteronism.The unilateral AV/IVC index can be used to diagnose unilateral primary aldosteronism during AVS. Combining CT results can increase the accuracy further.Primary aldosteronism is one of the most common causes of secondary hypertension, accounting for 4-14% of all hypertensive patients [1-4]. In this condition, autonomous secretion of aldosterone from one or both adrenal glands lead to inappropriate sodium retention, volume expansion, hypertension, and mineralocorticoid receptor-mediated cardiovascular injury [5]. Accurately differentiating unilateral from bilateral adrenal disease is crucial for patients with primary aldosteronism, as surgical intervention is recommended for unilateral primary aldosteronism (UPA) whereas bilateral primary aldosteronism (BPA) is typically treated with oral mineralocorticoid receptor antagonists such as spironolactone [6-8].The current subtyping methods mainly include adrenal computed tomography (CT) and adrenal vein sampling (AVS). As the accuracy of CT is only 52-81% [9-13], AVS is generally recommended to distinguish between UPA and BPA [14-17]. At present, lateralization of aldosterone excess is determined by the lateralization index, which is calculated from the aldosterone-cortisol ratio of one adrenal vein compared with the other following the successful cannulation of both adrenal veins [18]. However, AVS is a technically demanding procedure, with reported bilateral cannulation success rates of 21-95.6% [13,19-22]. Therefore, in the case of successful cannulation of just one adrenal vein, the lateralization index cannot be calculated and lateralization cannot be determined definitively.Several studies have suggested that, in the event of failed cannulation of one adrenal veins, the unilateral index, namely the aldosterone-cortisol ratio of the adrenal vein divided by the same ratio in the inferior vena cava (IVC), can distinguish between unilateral and bilateral primary aldosteronism [23-32]. Most studies have reported the unilateral AV/IVC index using ACTH-stimulated AVS [24-30,32]. One study reported the index based on non-ACTH stimulated AVS [23], which is common practice in many centres. Recently, Rossi et al.[31] reported the index based on AVS results with or without ACTH. However, the diagnostic performance and optimal cutoffs of the unilateral AV/IVC index vary among studies. Our study aims to determine the diagnostic performance and the optimal cutoffs of the unilateral AV/IVC index during non-ACTH-stimulated or ACTH-stimulated AVS for predicting unilateral aldosterone secretion. The cutoffs reported previously were also tested in our cohorts."

基金机构："National Natural Science Foundation of China [82100833, U21A20355]; Joint Medical Research Project of Chongqing Science and Technology Commission& Chongqing Health and Family Planning Commission [2022ZDXM003]; National key research & development plan of China [2021YFC2501603]; National Key Re-search and Development Project [2022YFC2505300, 2022YFC2505301, 2022YFC2505302, 2022YFC2505306]"

基金资助正文："This work is supported by the National Natural Science Foundation of China (82100833, recipient: Y.Y.; U21A20355, recipient: Q.L.); Joint Medical Research Project of Chongqing Science and Technology Commission & Chongqing Health and Family Planning Commission (Major Project, 2022ZDXM003, recipient: J.H.); National key research & development plan of China, major project of prevention and treatment for common diseases (2021YFC2501600, recipient: W.W.; sub-project:2021YFC2501603, recipient: Q.L.). The National Key Re-search and Development Project (2022YFC2505300, recipient: Y.M.; sub-project 2022YFC2505301, recipient: Q.L.;2022YFC2505302, recipient: Y.S.; 2022YFC2505306, recipient: Y.W.)."