title: A prospective evaluation of postural stimulation testing, computed tomography and adrenal vein sampling in the differential diagnosis of primary aldosteronism.
abstract: BACKGROUND
  In primary aldosteronism (PA), discriminating unilateral from bilateral disease is crucial because adrenalectomy is frequently curative in the former case but rarely helps in the latter. Various series have reported the utility of postural stimulation testing (PST), cross-sectional imaging and adrenal vein sampling (AVS) in the assessment of PA, but most of these studies were retrospective.
  
  
  OBJECTIVE
  To prospectively determine the diagnostic utility of PST, AVS and computed tomography (CT) using a radiological scoring system in the assessment of PA in a tertiary centre, as well as to document the incidence of autonomous cortisol cosecretion.
  
  
  METHODS
  Fifty consecutive patients with PA underwent PST, CT, AVS and a low-dose dexamethasone suppression test with measurement of serum cortisol at 48 h. For patients who underwent surgery, histological confirmation, and a normal postoperative serum aldosterone concentration and plasma renin activity were taken as evidence for unilateral disease. For other patients, results from successful adrenal vein sampling were the diagnostic evidence against which CT and PST were assessed.
  
  
  RESULTS
  Postural stimulation testing had a sensitivity and specificity of 44-56% and 71-75%, respectively. CT had an overall sensitivity and specificity of 77% and 80%, respectively, rising to 100% sensitivity and specificity if there was a single, discrete macronodule with an unequivocally normal contralateral gland. Evidence of cosecretion of cortisol occurred in 14% of patients.
  
  
  CONCLUSIONS
  Preliminary experience is presented of an objective radiological scoring system for selecting patients with PA for AVS. PST provides little, if any, useful additional information. A significant minority of patients with PA exhibit evidence of cortisol cosecretion, which may have implications for perioperative management.
authors: Department of Endocrinology, St Bartholomew's Hospital, London, UK.
authors: Jeshen H G
authors: JH
authors: Lau
authors: W C Candy
authors: WC
authors: Sze
authors: Rodney H
authors: RH
authors: Reznek
authors: Matthew
authors: M
authors: Matson
authors: Anju
authors: A
authors: Sahdev
authors: Robert
authors: R
authors: Carpenter
authors: Daniel M
authors: DM
authors: Berney
authors: Scott A
authors: SA
authors: Akker
authors: Shern L
authors: SL
authors: Chew
authors: Ashley B
authors: AB
authors: Grossman
authors: John P
authors: JP
authors: Monson
authors: William M
authors: WM
authors: Drake
mesh_terms: D000311:Adrenal Glands / Q000098:blood supply / Q000000981:diagnostic imaging*; D000328:Adult; D000368:Aged; D000450:Aldosterone / Q000097:blood; D002404:Catheterization; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D006929:Hyperaldosteronism / Q000175:diagnosis* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011187:Posture; D011446:Prospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods*
chemical_list: D000450:Aldosterone; D006854:Hydrocortisone