title: SFE/SFHTA/AFCE consensus on primary aldosteronism, part 4: Subtype diagnosis.
abstract: To establish the cause of primary aldosteronism (PA), it is essential to distinguish unilateral from bilateral adrenal aldosterone secretion, as adrenalectomy improves aldosterone secretion and controls hypertension and hypokalemia only in the former. Except in the rare cases of type 1 or 3 familial hyperaldosteronism, which can be diagnosed genetically and are not candidates for surgery, lateralized aldosterone secretion is diagnosed on adrenal CT or MRI and adrenal venous sampling. Postural stimulation tests and (131)I-norcholesterol scintigraphy have poor diagnostic value and (11)C-metomidate PET is not yet available. We recommend that adrenal CT or MRI be performed in all cases of PA. Imaging may exceptionally identify adrenocortical carcinoma, for which the surgical objectives are carcinologic, and otherwise shows either normal or hyperplastic adrenals or unilateral adenoma. Imaging alone carries a risk of false positives in patients over 35 years of age (non-aldosterone-secreting adenoma) and false negatives in all patients (unilateral hyperplasia). We suggest that all candidates for surgery over 35 years of age undergo adrenal venous sampling, simultaneously in both adrenal veins, without ACTH stimulation, to confirm the unilateral form of the hypersecretion. Sampling results should be confirmed on adrenal vein cortisol assay showing a concentration at least double that found in peripheral veins. Aldosterone secretion should be considered lateralized when aldosterone/cortisol ratio on the dominant side is at least 4-fold higher than contralaterally.
authors.affiliation: Service de médecine nucléaire, centre François-Baclesse, 3, avenue du Général-Harris, 14076 Caen cedex 05, France. Electronic address: sbardet@baclesse.unicancer.fr.
authors.forename: Stéphane
authors.initials: S
authors.lastname: Bardet
authors.affiliation: Service de médecine interne et d'hypertension artérielle, centre hospitalo-universitaire Rangueil, 31059 Toulouse, France. Electronic address: chamontin.b@chu-toulouse.fr.
authors.forename: Bernard
authors.initials: B
authors.lastname: Chamontin
authors.affiliation: Service d'endocrinologie et des maladies métaboliques, hôpital Huriez, centre hospitalier régional universitaire de Lille, rue Polonovski, 59037 Lille, France. Electronic address: douillard.claire@gmail.com.
authors.forename: Claire
authors.initials: C
authors.lastname: Douillard
authors.affiliation: Département de radiologie, hôpital européen Georges-Pompidou, Assistance publique-Hôpitaux de Paris, 75908 Paris, France. Electronic address: jean-yves.pagny@egp.aphp.fr.
authors.forename: Jean-Yves
authors.initials: JY
authors.lastname: Pagny
authors.affiliation: Département de radiologie, hôpital européen Georges-Pompidou, Assistance publique-Hôpitaux de Paris, 75908 Paris, France. Electronic address: anne.hernigou@egp.aphp.fr.
authors.forename: Anne
authors.initials: A
authors.lastname: Hernigou
authors.affiliation: Département de radiologie, centre hospitalo-universitaire Rangueil, 31059 Toulouse, France. Electronic address: francis.joffre0626@orange.fr.
authors.forename: Francis
authors.initials: F
authors.lastname: Joffre
authors.affiliation: Unité d'hypertension, Assistance publique-Hôpitaux de Paris, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75908 Paris cedex 15, France. Electronic address: pierre-francois.plouin@egp.aphp.fr.
authors.forename: Pierre-François
authors.initials: PF
authors.lastname: Plouin
authors.affiliation: Assistance publique-Hôpitaux de Paris, hôpital Tenon, service de médecine interne, rue de la Chine, 75020 Paris, France. Electronic address: olivier.steichen@tnn.aphp.fr.
authors.forename: Olivier
authors.initials: O
authors.lastname: Steichen
mesh_terms: D000310:Adrenal Gland Neoplasms / Q000175:diagnosis; D000311:Adrenal Glands / Q000098:blood supply / Q000000981:diagnostic imaging / Q000378:metabolism; D000328:Adult; D000367:Age Factors; D000450:Aldosterone / Q000097:blood / Q000378:metabolism; D005602:France; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D006929:Hyperaldosteronism / Q000175:diagnosis* / Q000209:etiology / Q000473:pathology; D006973:Hypertension; D007008:Hypokalemia; D008279:Magnetic Resonance Imaging; D014057:Tomography, X-Ray Computed; D014680:Veins
chemical_list: D000450:Aldosterone; D006854:Hydrocortisone
keywords: Adrenal vein sampling; Adénome sécrétant de l’aldostérone; Aldosterone; Aldosterone-secreting adenoma; Aldosteronism; Aldostérone; Cathétérisme veineux surrénal; Hyperaldostéronisme primaire; Primary