title: Despite limited specificity, computed tomography predicts lateralization and clinical outcome in primary aldosteronism.
abstract: BACKGROUND
  Computed tomography (CT) of the adrenals is a common first step for investigation of primary aldosteronism (PA). However, prior studies report poor specificity, necessitating adrenal vein sampling (AVS) prior to surgical consideration.
  
  
  METHODS
  We examined our AVS database to determine whether CT adrenal findings could help select patients with a high likelihood of lateralization by AVS or high-value blood pressure (BP) outcomes. Subjects (N = 113) with validated outcomes were divided into groups of CT 'positive' or CT 'negative' according to the presence or absence of an adrenal mass and compared for the outcomes of lateralization by AVS or proportions achieving normotension off medications following surgery.
  
  
  RESULTS
  For patients with CT adrenal masses, there was a significantly higher odds ratio (OR) for both outcomes (6.3 and 9.7, p < 0.01). In subgroup analysis, age <40 years carried particularly high odds for lateralization and cure when a CT mass was present (ORs 45 and 26, p < 0.01). Young individuals with normal CT adrenals rarely lateralized (10 %) and, in such patients, even factors like hypokalemia, body mass index (BMI), and plasma aldosterone level did not change the result on regression analysis.
  
  
  CONCLUSIONS
  CT-imaged adrenal masses strongly predicted lateralization by AVS and normotension with surgical treatment of lateralized PA. In PA, CT-positive patients should indeed be offered AVS and/or surgery given the high chance of good outcomes; younger CT-negative patients should be advised of a low chance of finding surgical disease by AVS.
authors.affiliation: Division of Endocrinology, Faculty of Medicine, University of Calgary, 1820 Richmond Rd SW, Calgary, AB, T2T 5C7, Canada, Gregory.kline@albertahealthservices.ca.
authors.forename: G A
authors.initials: GA
authors.lastname: Kline
authors.forename: V C
authors.initials: VC
authors.lastname: Dias
authors.forename: B
authors.initials: B
authors.lastname: So
authors.forename: A
authors.initials: A
authors.lastname: Harvey
authors.forename: J L
authors.initials: JL
authors.lastname: Pasieka
mesh_terms: D000236:Adenoma / Q000097:blood / Q000150:complications / Q000000981:diagnostic imaging*; D000310:Adrenal Gland Neoplasms / Q000097:blood / Q000150:complications / Q000000981:diagnostic imaging*; D000311:Adrenal Glands / Q000000981:diagnostic imaging*; D000328:Adult; D000367:Age Factors; D000450:Aldosterone / Q000097:blood; D001794:Blood Pressure; D005260:Female; D006801:Humans; D006929:Hyperaldosteronism / Q000097:blood / Q000000981:diagnostic imaging* / Q000209:etiology; D007008:Hypokalemia / Q000097:blood; D008297:Male; D008875:Middle Aged; D018962:Phlebotomy; D012083:Renin / Q000097:blood; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed
chemical_list: D000450:Aldosterone; D012083:Renin