The role of adrenal scintigraphy in the preoperative management of primary aldosteronism.
OBJECTIVE
Differentiation between the two major subgroups of primary aldosteronism, bilateral hyperplasia and aldosterone producing adenoma is essential since therapy in the former is medical and in the latter surgical. The aim of the present study was to evaluate the clinical utility of adrenocortical scintigraphy in the management of primary aldosteronism.


METHODS
[131I] norcholesterol (NP-59) scintigraphy with dexamethasone suppression for subclassification and lateralization of primary aldosteronism was evaluated in 49 patients with long-term follow-up after diagnosis and treatment.


RESULTS
Thirty-three patients with the diagnosis of aldosterone producing adenoma were operated with adrenalectomy. Preoperative scintigraphy showed lateralized isotope uptake in 27/33 patients while 6 showed no uptake. Twenty-two were cured and three significantly improved. Thus, in 25/33 (76%), scintigraphy showed the correct side as the patients benefited of surgery. Two patients did not improve. Fourteen patients with a probable diagnosis of bilateral hyperplasia had normal scintigraphies.


CONCLUSIONS
In the present retrospective study we found limited sensitivity of NP-59 scintigraphy. However, when a lateralized scintigraphic uptake is achieved it has a high accuracy. Scintigraphy may be used as an adjunct in cases where adrenal venous sampling is inconclusive.
Volpe
C
C
Department of Molecular Medicine and Surgery, Karolinska University Hospital Solna, Karolinska Institutet, Stockholm, Sweden.
Enberg
U
U
Sjögren
A
A
Wahrenberg
H
H
Jacobsson
H
H
Törring
O
O
Hamberger
B
B
Thorén
M
M
D000293:Adolescent; D000311:Adrenal Glands / Q000000981:diagnostic imaging*; D000315:Adrenalectomy / Q000379:methods*; D000328:Adult; D000368:Aged; D003937:Diagnosis, Differential; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006929:Hyperaldosteronism / Q000000981:diagnostic imaging* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care / Q000379:methods*; D011877:Radionuclide Imaging; D012189:Retrospective Studies; D013997:Time Factors; D055815:Young Adult