Noninvasive adrenal imaging in hyperaldosteronism: is it accurate for correctly identifying patients who should be selected for surgery?
OBJECTIVE
The most common causes of hyperaldosteronism (HA) are bilateral idiopathic hyperaldosteronism (IHA), aldosterone-producing adenoma (APA), and unilateral primary adrenal hyperplasia (PAH). We evaluated if non-invasive preoperative imaging studies are able to reliably differentiate these causes of hyperaldosteronism.


METHODS
The medical records of 50 consecutive patients with HA were reviewed. Follow up was obtained by outpatient consultation or phone contact.


RESULTS
Thirty-five patients (70%) underwent successful adrenalectomy for APA, basing on the computed tomography (CT) scan results only. All these patients were biochemically cured. The remaining 15 patients underwent dexamethasone suppression adrenal cortical scintiscan (ACS) because of equivocal or inconclusive CT scan. In 11 of these patients, ACS showed a bilateral uptake, suggesting IHA. They were followed-up. In the remaining four patients, ACS showed a unilateral uptake. These patients underwent adrenalectomy. Final histology showed APA in three patients and PAH in one. They were biochemically cured. Sensitivity of combined non-invasive imaging procedures (CT and ACS) in detecting histologically proven and biochemically cured APA and PAH was 100%.


CONCLUSIONS
Non-invasive adrenal imaging studies are accurate in distinguishing between IHA and APA/PAH. Invasive diagnostic tests (adrenal venous sampling) should be indicated only when they do not conclusively localize hypersecretion.
Lombardi
Celestino Pio
CP
Divisione di Endocrinochirurgia, Istituto di Clinica Chirurgica, Università Cattolica del Sacro Cuore, Largo A. Gemelli, 8, 00168, Rome, Italy.
Raffaelli
Marco
M
De Crea
Carmela
C
Rufini
Vittoria
V
Treglia
Giorgio
G
Bellantone
Rocco
R
D000236:Adenoma / Q000175:diagnosis* / Q000235:genetics / Q000473:pathology / Q000601:surgery*; D000301:Adosterol; D000310:Adrenal Gland Neoplasms / Q000175:diagnosis* / Q000235:genetics / Q000473:pathology / Q000601:surgery*; D000311:Adrenal Glands / Q000473:pathology*; D000315:Adrenalectomy; D000328:Adult; D000368:Aged; D000450:Aldosterone / Q000097:blood; D003907:Dexamethasone; D003937:Diagnosis, Differential; D003952:Diagnostic Imaging; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D006929:Hyperaldosteronism / Q000175:diagnosis* / Q000209:etiology* / Q000235:genetics / Q000473:pathology; D006965:Hyperplasia / Q000175:diagnosis / Q000235:genetics / Q000473:pathology / Q000601:surgery; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011877:Radionuclide Imaging; D012083:Renin / Q000097:blood; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D055815:Young Adult
D000450:Aldosterone; D000301:Adosterol; D003907:Dexamethasone; D012083:Renin; D006854:Hydrocortisone