Clinical Prediction Score of Leung et al for Distinguishing an Aldosterone-Producing Adenoma from Idiopathic Adrenal Hyperplasia in Primary Aldosteronism
Leung et al reported a clinical prediction score for evaluating a patient with primary aldosteronism. This can help to distinguish an aldosterone-producing adenoma (APA) from idiopathic adrenal hyperplasia (IAH). The authors are from Ruttonjee Hospital, The University of Hong Kong, Pamela Youde Nethersole Eastern Hospital and Princess Margaret Hospital in Hong Kong.
Patient selection: primary aldosteronism
Features of an aldosterone-producing adenoma vs hyperplasia:
(1) higher plasma aldosterone after saline infusion
(2) lower (suppressed) plasma renin activity before saline infusion
(3) mean age of 49 years
Parameters:
(1) age at diagnosis in years
(2) plasma renin activity (PRA) before saline infusion test (SIT) in ng/mL/h
(3) plasma aldosterone concentration after saline infusion test (SIT) pmol/L
Parameter
Finding
Points
age at diagnosis
< 50 years
1
>= 50 years
0
plasma renin activity
<= 0.26 ng/mL/h
1
> 0.26 ng/mL/h
0
aldosterone concentration
< 424 pmol/L
0
>= 424 pmol/L
1
total score =
= SUM(points for all of the parameters)
Interpretation:
• minimum score: 0
• maximum score: 3
• The higher the score the greater the likelihood of aldosterone-producing adenoma (APA).
Score
Sensitivity for APA
Specificity for APA
2
84%
88%
3
32%
100%
Performance:
• The area under the ROC curve is 0.91.
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