SynthesisBMJ open2020
Diagnostic accuracy of adrenal imaging for subtype diagnosis in primary aldosteronism: systematic review and meta-analysis.
Synthesis in BMJ open, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 2 registered trials, which are not on this map. Cited by 20 papers, 2 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
The Long-term Effect of Superselective Adrenal Arterial Embolization and Medical Treatment for Primary Aldosteronism on Cardiorenovascular Protection, Blood Pressure, and the Endocrinological Profile.
Unilateral Primary Aldosteronism, Mineralocorticoid Antagonists Versus Surgical Treatment - A Randomized Controlled Trial
Who cites it
20 citing papers in PubMed, 2 syntheses or guidelines pooled it, 32 citations in OpenAlex.
- Adrenal Vein Sampling for Primary Aldosteronism: Recommendations From the Australian and New Zealand Working Group.Clinical endocrinology · 2025Guideline
- Assessment of performance of stratum-specific likelihood ratios of the aldosteronoma resolution score for predicting hypertension cure after adrenalectomy for primary aldosteronism: a systematic review and meta-analysis.Journal of human hypertension · 2023Pooled it
- Clinical value of multi-time-pointEndocrine · 2026Article
- ⁶⁸GA-Pentixafor PET/CT: a non-invasive molecular alternative to adrenal venous sampling in primary aldosteronism.EJNMMI reports · 2026Review
- Optimizing the diagnosis of primary aldosteronism: The role of adrenal vein sampling and the need for high-expertise reference centers.Journal of neuroendocrinology · 2026Observational
- Machine learning-based prediction of primary aldosteronism subtype using comprehensive clinical features.Scientific reports · 2026Article
- Emerging methods for subtype differentiation in primary aldosteronism.Journal of internal medicine · 2026Review
- Identifying unilateral aldosterone-producing adenomas using published algorithms and imaging: a systematic review and meta-analysis.Endocrine connections · 2025Article
- Validation of a new non-invasive predictive score (KASAI) for primary aldosteronism subtyping.Endocrine connections · 2025Article
- Development and validation of prediction models for special subtype of primary aldosteronism: patients with negative adrenal CT imaging.Frontiers in endocrinology · 2025Article
- Treating Primary Aldosteronism-Induced Hypertension: Novel Approaches and Future Outlooks.Endocrine reviews · 2024Article
- Key to the Treatment of Primary Aldosteronism in Secondary Hypertension: Subtype Diagnosis.Current hypertension reports · 2023Review
- The performance of left/right adrenal volume ratio and volume difference in predicting unilateral primary aldosteronism.Journal of endocrinological investigation · 2023Article
- Integration of clinical parameters and CT-based radiomics improves machine learning assisted subtyping of primary hyperaldosteronism.Frontiers in endocrinology · 2023Article
- Primary Aldosteronism: State-of-the-Art Review.American journal of hypertension · 2022Article
- Primary aldosteronism - a multidimensional syndrome.Nature reviews. Endocrinology · 2022Review
- Response to Letter to the Editor From Singhania et al.: "Increasing Incidence of Primary Aldosteronism in Western Sweden During 3 Decades - Yet an Underdiagnosed Disorder".The Journal of clinical endocrinology and metabolism · 2022Article
- Unilateral primary aldosteronism considerations about the diagnostic criteria, adrenalectomy, and short and long time biochemical and clinical evaluation.Journal of clinical hypertension (Greenwich, Conn.) · 2022Article
- A new machine learning-based prediction model for subtype diagnosis in primary aldosteronism.Frontiers in endocrinology · 2022Article
- Should Adrenal Venous Sampling Be Performed in PA Patients Without Apparent Adrenal Tumors?Frontiers in endocrinology · 2021Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
7 authors at 1 institution in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectivesAccurate subtype classification in primary aldosteronism (PA) is critical in assessing the optimal treatment options. This study aimed to evaluate the diagnostic accuracy of adrenal imaging for unilateral PA classification.
methodsSystematic searches of PubMed, EMBASE and the Cochrane databases were performed from 1 January 2000 to 1 February 2020, for all studies that used CT or MRI in determining unilateral PA and validated the results against invasive adrenal vein sampling (AVS). Summary diagnostic accuracies were assessed using a bivariate random-effects model. Subgroup analyses, meta-regression and sensitivity analysis were performed to explore the possible sources of heterogeneity.
resultA total of 25 studies, involving a total of 4669 subjects, were identified. The overall analysis revealed a pooled sensitivity of 68% (95% CI: 61% to 74%) and specificity of 57% (95% CI 50% to 65%) for CT/MRI in identifying unilateral PA. Sensitivity was higher in the contrast-enhanced (CT) group versus the traditional CT group (77% (95% CI 66% to 85%) vs 58% (95% CI 50% to 66%). Subgroup analysis stratified by screening test for PA showed that the sensitivity of the aldosterone-to-renin ratio (ARR) group was higher than that of the non-ARR group (78% (95% CI 69% to 84%) vs 66% (95% CI 58% to 72%)). The diagnostic accuracy of PA patients aged ≤40 years was reported in four studies, and the overall sensitivity was 71%, with 79% specificity. Meta-regression revealed a significant impact of sample size on sensitivity and of age and study quality on specificity.
conclusionCT/MRI is not a reliable alternative to invasive AVS without excellent sensitivity or specificity for correctly identifying unilateral PA. Even in young patients (≤40 years), 21% of patients would have undergone unnecessary adrenalectomy based on imaging results alone.
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What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.