Kupers et al developed a simple score for identifying a patient with a unilateral adenoma causing primary aldosteronism. This can reduce the need for adrenal venous sampling (AVS). The authors are from multiple hospitals in Paris.
Patient selection: primary aldosteronism
Parameters:
(1) typical Conn’s adenoma on imaging studies >= 8 mm in diameter on CT scan
(2) serum potassium
(3) estimated GFR usng the MDRD equation in mL per min per 1.73 square meters
Parameter
Finding
Points
typical Conn’s adenoma
absent
0
present
3
serum potassium
>= 3.5 mmol/L
0
< 3.5 mmol/L
2
eGFR
>= 100
2
80 to 99
1
< 80
0
total score =
= SUM(points for all all 3 parameters)
Interpretation:
• minimum score: 0
• maximum score: 7
• The higher the score the greater the likelihood of a lateralized adrenal venous sampling.
• A score >= 5 was 100% specific but a score of 5 was only about 45% sensitive. A patient with a score >= 5 can undergo surgery without AVS.
The authors also noted that a typical adenoma >= 10 mm in diameter on CT in a patient <= 40 years of age indicates lateralized AVS. Such a patient can go to surgery without AVS.
If the patient does not meet a critera that localized the adenoma then AVS should be attempted.
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