The Primary Aldosteronism Surgical Outcome (PASO) Score can help to predict how successful adrenalectomy will be in a patient with unilateral primary aldosteronism. The authors are from multiple institutions from around the world.
Patient selection: status post adrenalectomy for unilateral primary aldosteronism
Parameters:
(1) known duration of hypertension
(2) sex
(3) antihypertensive medication dosage in DDD (defined daily dose; assumed average maintenance dose per day for a drug)
(4) body mass index
(5) target organ damage (left ventricular hypertrophy and/or microalbuminuria)
(6) size of the largest nodule on imaging in mm
|
Parameter |
Finding |
Points |
|
duration of hypertension |
< 120 months |
7.5 |
|
|
120-238 months |
3.5 |
|
|
>= 239 months |
0 |
|
sex |
male |
0 |
|
|
female |
3 |
|
antihypertensive drug in defined daily dose |
< 3 |
6 |
|
|
3 to 8.99 |
3 |
|
|
>= 9 |
0 |
|
body mass index |
< 24 kg per sq m |
1.5 |
|
|
24 to 29.9 kg per sq m |
0.5 |
|
|
>= 30 kg per sq m |
0 |
|
target organ damage |
no |
3 |
|
|
yes |
0 |
|
largest nodules diameter |
< 13 mm |
0 |
|
|
13 to 19 mm |
2 |
|
|
>= 20 mm |
4 |
where:
• Based on the downloadable model listed in the paper, the DDD is determined by (1) entering the dose of each antihypertensive drug, (2) dividing this dose by the average maintenance dose for the drug, (3) summing the results.
Interpretation:
• minimum score: 0
• maximum score: 25
• The higher the score the better the chances of surgery being successful (normalization of blood pressure without the aid of antihypertensive medication).
• The optimum cutoff is > 16.
|
Score |
Complete Success |
Partial Success |
|
0 to 2 |
0% |
100% |
|
2.1 to 4 |
11.1% |
88.9% |
|
4.1 to 6 |
7.1% |
78.6% |
|
6.1 to 8 |
3.2% |
58.1% |
|
8.1 to 10 |
16.1% |
71% |
|
10.1 to 12 |
14.5% |
67.3% |
|
12.1 to 14 |
20% |
50.9% |
|
14.1 to 16 |
39% |
48.8% |
|
16.1 to 18 |
66.7% |
26.3% |
|
18.1 to 20 |
73.7% |
18.4% |
|
20.1 to 22 |
76% |
20% |
|
22.1 to 24 |
92.9% |
7.1% |
|
24.1 to 25 |
100% |
Performance:
• The area under the ROC curve is 0.84.
• At the cutoff the sensitivity is 84% and sensitivity 71%.
Specialty: Endocrinology
