CT of primary hyperaldosteronism (Conn's syndrome): the value of measuring the adrenal gland.
OBJECTIVE
The objectives of our study of patients with primary hyperaldosteronism (Conn's syndrome) were to determine whether the adrenal glands are larger in patients with bilateral adrenal hyperplasia than in those with aldosterone-producing adenomas or in healthy control subjects; and whether a CT criterion based on adrenal gland size can be developed to positively diagnose bilateral adrenal hyperplasia.


METHODS
A retrospective study of CT scans of 28 patients with primary hyperaldosteronism was performed. The means of two observers' measurements of adrenal gland size were recorded and compared with published normal values. In addition, a radiologist experienced in adrenal imaging and unaware of the cause of the primary hyperaldosteronism diagnosed either bilateral adrenal hyperplasia or aldosterone-producing adenoma by visual inspection.


RESULTS
The adrenal glands in patients with bilateral adrenal hyperplasia were significantly (p < 0.05) larger than those in patients with aldosterone-producing adenoma or in healthy control subjects. A sensitivity of 100% was achieved when a mean limb width of greater than 3 mm was used to diagnose bilateral adrenal hyperplasia, and a specificity of 100% was achieved when the mean limb width was 5 mm or greater. Receiver operating characteristic curve analysis showed that the overall performance of the radiologist and the mean adrenal limb width in detecting bilateral adrenal hyperplasia were equivalent.


CONCLUSIONS
In patients with primary hyperaldosteronism, adrenal limb measurements on CT can aid in differentiating bilateral adrenal hyperplasia from aldosterone-producing adenoma because the adrenal glands in bilateral adrenal hyperplasia are larger.
Lingam
R K
RK
Department of Diagnostic Imaging, St. Bartholomew's Hospital, West Smithfield, London EC1A 7BE, United Kingdom.
Sohaib
S A
SA
Vlahos
I
I
Rockall
A G
AG
Isidori
A M
AM
Monson
J P
JP
Grossman
A
A
Reznek
R H
RH
D000311:Adrenal Glands / Q000000981:diagnostic imaging*; D000312:Adrenal Hyperplasia, Congenital / Q000000981:diagnostic imaging*; D018246:Adrenocortical Adenoma / Q000000981:diagnostic imaging*; D000328:Adult; D000368:Aged; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D006929:Hyperaldosteronism / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed