In the Journals

Clinical prediction score not superior to image-based diagnosis of primary aldosteronism

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January 24, 2014

The clinical prediction score may potentially lead to occasional decision-making errors in patient selection for adrenalectomy in those with unilateral primary aldosteronism, according to study results.

However, because clinical decision-making in primary aldosteronism remains a challenge for clinicians, the clinical prediction score (CPS) may have a role in guiding clinical decision-making, especially in those whose adrenal venous sampling has been unsuccessful.

Study researchers analyzed data on 75 patients with primary aldosteronism. All patients had a robust diagnosis after bilateral adrenal venous cannulation and/or strictly defined surgical outcome. A sensitivity of 38.8% and a specificity of 88.5% of correctly identifying unilateral aldosterone production was calculated when researchers applied CPS to this group of patients.

CPS is a recently developed and published scoring system to diagnose unilateral primary aldosteronism without recourse to adrenal venous sampling. 

Researchers then used a suggested modification to the CPS in which different levels of hypokalemia were given different weightings. With this model, the sensitivity rose to 40.8%, with an identical specificity as the original analysis. Using a radiological grading score improved sensitivity to 91.7%, but specificity was reduced to 62.5%.

“In summary, we have used a recently published CPS to interrogate a prospectively gathered data set from a cohort of patients with primary aldosteronism. The data set presented here includes robustly defined surgical outcomes, which suggest that the CPS has the potential (in this group of patients) to lead to occasional erroneous decision-making regarding patient selection for adrenalectomy. We do not present these data by way of criticism of the developed CPS; more to emphasize that clinical decision-making in primary aldosteronism remains a challenge for clinicians. The CPS may provide useful adjunctive information for clinical decision-making in cases of unsuccessful [adrenal venous sampling] or in centres where the technical expertise for [adrenal venous sampling] is not available,” the researchers wrote.

Disclosure: The researchers report no relevant financial disclosures.

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