title: [An abdominal CT scan in first-line is an efficient investigation of uncontrolled hypertensives suspected to have an adrenal cause].
abstract: The prevalence of hypertension resistant to treatment to indicate for renal denervation.
  
  
  OBJECTIVE
  To evaluate the efficiency for imaging the adrenal glands with an abdominal CT scan in first-line in subjects with resistant hypertension suspected to have an adrenal cause.
  
  
  METHODS
  On 75 hypertensive patients uncontrolled by at least a combination therapy, but suspected to have secondary hypertension due to adrenal cause, an abdominal CT scan was performed in first intention. In all subjects, an exploration of the renin-aldosteron axis in standardized conditions, a 24-hour urinary cortisol and a WHO recommended biological analysis were also performed.
  
  
  RESULTS
  An abnormal morphology of adrenal was found by abdominal CT in 64% of patients. The abnormalities observed were: bilateral hyperplasia (27%), unilateral adenoma (15%), unilateral hyperplasia (15%), bilateral adenoma (7%). Abnormal biological and/or hormonal tests for adrenal disease were found in 29% of patients, with a primary aldosteronism (A/R corrected>23) in 11% or K less than 3.5mmol/L in 20%. According to the assessment conducted in first-line, indication to spironolactone is selected in 48% of patients investigated with CT as first-line and in 17% of patients investigated with biological tests (P<0.01) while the indication to adrenal surgery would be held in 15% and 11% of patients respectively.
  
  
  CONCLUSIONS
  In a population of subjects with uncontrolled hypertension in which an adrenal cause is suspected, achieving a first-line abdominal CT leads to adrenal abnormality observed in 64% of patients while a specific biological abnormality is noted in 29% of subjects. This study shows that assessment that starts with an abdominal CT scan allows to indicate treatment with spironolactone more frequently than when the first assessment is limited to a biological investigation.
authors: Unité de prévention cardiovasculaire, pôle cœur métabolisme, hôpital de La Pitié-Salpêtrière, 83, boulevard de l'Hôpital, 75651 Paris cedex 13, France.
authors: D
authors: D
authors: Rosenbaum
authors: J
authors: J
authors: Rigabert
authors: F
authors: F
authors: Villeneuve
authors: X
authors: X
authors: Girerd
mesh_terms: D000306:Adrenal Cortex Neoplasms / Q000150:complications / Q000000981:diagnostic imaging*; D000311:Adrenal Glands / Q000000981:diagnostic imaging / Q000378:metabolism / Q000473:pathology; D018246:Adrenocortical Adenoma / Q000150:complications / Q000000981:diagnostic imaging*; D000328:Adult; D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use; D015415:Biomarkers / Q000652:urine; D003937:Diagnosis, Differential; D005260:Female; D006785:Hospitals, University; D006801:Humans; D006854:Hydrocortisone / Q000652:urine*; D006929:Hyperaldosteronism / Q000150:complications / Q000000981:diagnostic imaging* / Q000209:etiology; D006965:Hyperplasia; D006973:Hypertension / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed
chemical_list: D000959:Antihypertensive Agents; D015415:Biomarkers; D006854:Hydrocortisone