THU593 Unilaterally Selective Adrenal Vein Sampling For Identification Of Surgically Curable Primary Aldosteronism

Disclosure: G. Rossi: None. D. Bagordo: None. L. Amar: None. M. Azizi: None. A. Riester: None. M. Reincke: None. C. Degenhart: None. J. Widimský: None. M. Naruse: None. J. Deinum: None. T. Kocjan: None. A. Negro: None. E. Rossi: None. G. Kline: None. A. Tanabe: None. F. Satoh: None. L. Rump: None. O. Vonend: None. H.S. Willenberg: None. P.J. Fuller: None. J. Yang: None. N. Chee: None. S.B. Magill: None. Z. Shafigullina: None. M. Quinkler: None. A. Oliveras: None. B. Lee: None. C. Chang: None. V. Wu: None. Z. Krátká: None. M. Battistel: None. G. Rossitto: None. T.M. Seccia: None. Adrenal venous sampling is recommended for the identification of unilateral surgically curable primary aldosteronism, but is often clinically useless, owing to failed bilateral adrenal vein cannulation. Our objective was to investigate if only unilaterally selective adrenal vein sampling studies can allow identification of the responsible adrenal. Among 1625 patients consecutively submitted to adrenal vein sampling in tertiary referral centers, we selected those with selective adrenal vein sampling result in at least on side and surgically cured unilateral primary aldosteronism, used as gold reference. The accuracy of different values of the relative aldosterone secretion index (RASI), which estimates the amount of aldosterone produced in each adrenal gland corrected for catheterization selectivity, was examined. We found prominent differences of RASI values distribution between patients with and without unilateral primary aldosteronism. The diagnostic accuracy of RASI values estimated by the area under ROC curves (AUROC) was 0.714 and 0.855, respectively, in the responsible and the contralateral side; RASI values >2.55 and ≤0.96 on former and the latter side furnished the highest accuracy for detection of surgically cured unilateral primary aldosteronism. Moreover, in the patients without unilateral primary aldosteronism only 20% and 16% had RASI values ≤0.96 and >2.55. With the strength of large real-life dataset and use of the gold reference entailing an unambiguous diagnosis of unilateral primary aldosteronism, these results indicate the feasibility of identifying unilateral primary aldosteronism using unilaterally selective adrenal vein sampling results. Presentation: Thursday, June 15, 2023