Michio Otsuki    Department   School of Medicine(Tokyo Women's Medical University Hospital), School of Medicine    Position   Professor and Division head
Article types	Original article
Language	English
Peer review	Peer reviewed
Title	Significance of Computed Tomography and Serum Potassium in Predicting Subtype Diagnosis of Primary Aldosteronism
Journal	Formal name：The Journal of clinical endocrinology and metabolism Abbreviation：J Clin Endocrinol Metab ISSN code：0021972x
Domestic / Foregin	Foregin
Volume, Issue, Page	103(3),pp.900-908
Author and coauthor	Umakoshi, H. Tsuiki, M. Takeda, Y. Kurihara, I. Itoh, H. Katabami, T. Ichijo, T. Wada, N. Yoshimoto, T. Ogawa, Y. Kawashima, J. Sone, M. Inagaki, N. Takahashi, K. Watanabe, M. Matsuda, Y. Kobayashi, H. Shibata, H. Kamemura, K. Otsuki, M. Fujii, Y. Yamamto, K. Ogo, A. Yanase, T. Suzuki, T. Naruse, M.
Publication date	2018
Summary	Context: The number of centers with established adrenal venous sampling (AVS) programs for the subtype diagnosis of primary aldosteronism (PA) is limited. Objective: Aim was to develop an algorithm for AVS based on subtype prediction by computed tomography (CT) and serum potassium. Design: A multi-institutional retrospective cohort study in Japan. Patients: A total of 1591 patients with PA were classified into four groups according to CT findings and potassium status. Subtype diagnosis of PA was determined by AVS. Main Outcome Measure: Prediction value of the combination of CT findings and potassium status for subtype diagnosis. Results: The percentages of unilateral hyperaldosteronism on AVS were higher in patients with unilateral disease on CT than those with bilateral normal results on CT (50.8% vs 14.6%, P<0.01), and these percentages were higher in those with hypokalemia than those with normokalemia (58.4% vs 11.5%, P<0.01). The prevalence and odds ratio for unilateral hyperaldosteronism on AVS were as follows: bilateral normal on CT with normokalemia, 6.2% (reference); unilateral disease on CT with normokalemia, 23.8% and 4.8 [95% confidence interval (CI), 3.1 to 7.2]; bilateral normal on CT with hypokalemia, 38.1% and 9.4 (95% CI, 6.2 to 14.1), and unilateral disease on CT with hypokalemia, 70.6% and 36.4 (95% CI, 24.7 to 53.5). Conclusions: Patients with PA with bilateral normal results on CT and normokalemia likely have a low prior probability of a lateralized form of AVS and could be treated medically, whereas those with unilateral disease on CT and hypokalemia have a high probability of a lateralized form of AVS.
DOI	10.1210/jc.2017-01774
Document No.	29092077