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Plasma samples were collected at baseline from all patients and again from PA patients after adrenalectomy. Deep proteomic analysis was performed to identify peptide signatures used to develop a classification model distinguishing PA from EH in the training cohort. The classification model was subsequently tested in the validation cohort and post\u2010adrenalectomy PA patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>After proteomic analysis, six peptide features including HBB, FIBA, Complement CO7, ALBU, C4BPA, and A2AP were selected to generate risk scores and develop a classification model for distinguishing unilateral PA from EH. Risk scores were significantly higher in PA patients compared to those with EH. The classification model had a sensitivity and specificity of 80.5% and 83.3%, respectively, for diagnosing unilateral PA in the training cohort, and 81.8% and 80.0% in the validation cohort. The model demonstrated strong performance with an area under the curve of .92 for distinguishing hypertensive patients with or without PA. Post\u2010unilateral adrenalectomy, the risk scores showed a significant decrease.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Proteomic analysis can identify peptide signatures that effectively distinguish unilateral PA from EH. These findings underscore the potential utility of proteomics as an adjunct diagnostic and monitoring tool in the clinical management of PA.<\/jats:p><\/jats:sec>","DOI":"10.1111\/eci.70081","type":"journal-article","created":{"date-parts":[[2025,5,29]],"date-time":"2025-05-29T08:16:03Z","timestamp":1748506563000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Proteomic signatures to detect unilateral primary aldosteronism in hypertensive patients"],"prefix":"10.1111","volume":"55","author":[{"given":"Cheng\u2010Hsuan","family":"Tsai","sequence":"first","affiliation":[{"name":"National Taiwan University College of Medicine, Graduate Institute of Clinical Medicine  Taipei Taiwan"},{"name":"Primary Aldosteronism Center at National Taiwan University Hospital  Taipei Taiwan"},{"name":"Division of Cardiology, Department of Internal Medicine National Taiwan University Hospital and National Taiwan University College of Medicine  Taipei Taiwan"},{"name":"Center for Adrenal Disorders, Division of Endocrinology, Diabetes, and Hypertension Brigham and Women's Hospital, Harvard Medical School  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Po\u2010Hsin","family":"Kong","sequence":"additional","affiliation":[{"name":"Institute of Biomedical Sciences, National Sun Yat\u2010Sen University  Kaohsiung Taiwan"},{"name":"Marker X Co., ltd.  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