title: Predictive value of preoperative tests in discriminating bilateral adrenal hyperplasia from an aldosterone-producing adrenal adenoma.
abstract: In primary hyperaldosteronism, discriminating bilateral adrenal hyperplasia (BAH) from an aldosterone-producing adenoma (APA) is important because adrenalectomy, which is usually curative in APA, is seldom effective in BAH. We analyzed the results from our most recent 7-yr series to evaluate the predictive value of preoperative noninvasive tests compared with adrenal vein sampling (AVS). Forty-eight patients with hypertensive hyperaldosteronism underwent bedside testing, computed tomography (CT) imaging, and AVS. Those in whom the results of AVS indicated APA underwent adrenalectomy. Twelve (30%) and 14 (34%) of 41 patients with APA had paradoxical falls with ambulation in plasma aldosterone concentration (PAC) and 18-hydroxycorticosterone (18-OH-B), respectively. Twenty-nine (70%) and 26 (65%) APA patients had a rise in PAC and 18-OH-B, respectively, as did all 8 BAH patients. Significant identifiers of BAH were supine PAC values less than 15 ng/dL (P: = 0.04), an increase greater than 60% (P: = 0.02) in PAC with ambulation, and supine 18-OH-B values less than 60 ng/dL (P: = 0.04). CT imaging alone was not predictive for BAH or APA. In our population, patients with a positive bedside test result (e.g. a fall in PAC and/or 18-OH-B) and a unilateral adrenal nodule on CT (10 of 41 patients) could have proceeded directly to adrenalectomy for APA. However, a positive bedside test result with a negative CT or a negative bedside test result regardless of CT findings required AVS to confirm the diagnosis and site of disease.
authors.affiliation: Urologic Oncology Branch/National Cancer Institute, National Cancer Institute, Bethesda, MD 20892-1501, USA.
authors.forename: J L
authors.initials: JL
authors.lastname: Phillips
authors.forename: M M
authors.initials: MM
authors.lastname: Walther
authors.forename: J C
authors.initials: JC
authors.lastname: Pezzullo
authors.forename: W
authors.initials: W
authors.lastname: Rayford
authors.forename: P L
authors.initials: PL
authors.lastname: Choyke
authors.forename: A A
authors.initials: AA
authors.lastname: Berman
authors.forename: W M
authors.initials: WM
authors.lastname: Linehan
authors.forename: J L
authors.initials: JL
authors.lastname: Doppman
authors.forename: J R
authors.initials: JR
authors.lastname: Gill
mesh_terms: D000236:Adenoma / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000378:metabolism; D000310:Adrenal Gland Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000378:metabolism; D000312:Adrenal Hyperplasia, Congenital / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000378:metabolism; D000315:Adrenalectomy; D000324:Adrenocorticotropic Hormone / Q000097:blood; D000450:Aldosterone / Q000097:blood / Q000378:metabolism*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D006929:Hyperaldosteronism / Q000175:diagnosis* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D010835:Phytohemagglutinins / Q000378:metabolism; D019095:Point-of-Care Systems; D011187:Posture / Q000502:physiology; D014057:Tomography, X-Ray Computed; D016138:Walking / Q000502:physiology
chemical_list: D010835:Phytohemagglutinins; D000450:Aldosterone; D000324:Adrenocorticotropic Hormone