Kobayashi et al reported a score for evaluating a patient with primary hyperaldosteronism. This can help to distinguish unilateral from bilateral disease. The authors are from multiple institutions in Japan.
Patient selection: primary hyperaldosteronism
Parameters:
(1) serum potassium in mmol/L
(2) adrenal nodule on abdominal CT
(3) baseline plasma aldosterone concentration in pg per mL
(4) baseline aldosterone/renin ratio
(5) sex
aldosterone to renin activity ratio =
= (aldosterone in pg/mL) / (renin activity in ng/mL per hour)
Parameters
Findings
Points
serum potassium
< 3.5 mmol/L
0
3.5 to 3.9 mmol/L
3
>= 4.0 mmol/L
4
adrenal nodule
no
3
yes
0
baseline plasma aldosterone
< 210 pg/mL
2
>= 210 pg per mL
0
baseline aldosterone to renin ratio
< 620
2
>= 620
0
sex
male
0
female
1
total score =
= SUM(points for all 5 parameters)
Interpretation:
• minimum score: 0
• maximum score: 12
• The higher the score the greater the risk of bilateral disease.
Score
Bilateral Disease
0 or 1
15%
2 to 5
43%
6 or 7
79%
8 to 12
94%
Performance:
• The area under the ROC curve is 0.87.
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