title: Accuracy of adrenal imaging and adrenal venous sampling in diagnosing unilateral primary aldosteronism.
abstract: BACKGROUND
  The correct differentiation between unilateral and bilateral adrenal involvement in patients with primary aldosteronism (PA) is of utmost importance to justify surgical treatment. The aim of this study was to determine the accuracy of adrenal imaging compared to adrenal venous sampling (AVS), histopathology and postoperative outcome.
  
  
  METHODS
  The data of all patients with unequivocal AVS who underwent unilateral laparoscopic adrenalectomy for primary aldosteronism between May 2004 and April 2015 were entered in this retrospective study. We compared computed tomography (CT) and magnetic resonance imaging (MRI) results with corresponding AVS data, histopathology findings and postoperative outcome.
  
  
  RESULTS
  A total of 175 patients underwent unilateral laparoscopic adrenalectomy for primary aldosteronism. AVS was successful in 152 patients and postoperative outcome available in 148 patients. Despite unilateral disease according to AVS results, bilateral normal glands were seen in 15 MRI (17·2%) and 7 CT scans (8·5%), respectively. Unilateral enlargement of the nonhypersecreting adrenal gland was found in three MRI (3·5%) and 10 CT scans (12·2%) of patients who showed aldosterone hypersecretion deriving from the contralateral gland. Fifteen MRI (17·2%) and 18 CT scans (22·0%) revealed bilateral adrenal pathology despite unilateral aldosterone hypersecretion.
  
  
  CONCLUSIONS
  The accuracy of CT and magnetic resonance imaging in predicting unilateral disease is poor. AVS appears to be an essential diagnostic step to identify those patients who may benefit from unilateral adrenalectomy.
authors.affiliation: Chirurgische Klinik II, Campus Innenstadt, Ludwig-Maximilians Universität München, Munich, Germany.
authors.forename: Roland
authors.initials: R
authors.lastname: Ladurner
authors.affiliation: Chirurgische Klinik II, Campus Innenstadt, Ludwig-Maximilians Universität München, Munich, Germany.
authors.forename: Sandra
authors.initials: S
authors.lastname: Sommerey
authors.affiliation: Chirurgische Klinik II, Campus Innenstadt, Ludwig-Maximilians Universität München, Munich, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Buechner
authors.affiliation: Medizinische Klinik IV, Campus Innenstadt, Ludwig-Maximilians Universität München, Munich, Germany.
authors.forename: Anna
authors.initials: A
authors.lastname: Dietz
authors.affiliation: Institut für klinische Radiologie, Campus Innenstadt, Ludwig-Maximilians Universität München, Munich, Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Degenhart
authors.affiliation: Chirurgische Klinik II, Campus Innenstadt, Ludwig-Maximilians Universität München, Munich, Germany.
authors.forename: Klaus
authors.identifier: http://orcid.org/0000-0001-8932-4201
authors.initials: K
authors.lastname: Hallfeldt
authors.affiliation: Chirurgische Klinik II, Campus Innenstadt, Ludwig-Maximilians Universität München, Munich, Germany.
authors.forename: Julia
authors.initials: J
authors.lastname: Gallwas
mesh_terms: D000306:Adrenal Cortex Neoplasms / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000601:surgery; D000307:Adrenal Gland Diseases / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D000315:Adrenalectomy; D018246:Adrenocortical Adenoma / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000601:surgery; D000328:Adult; D000368:Aged; D000450:Aldosterone / Q000032:analysis; D001800:Blood Specimen Collection; D005260:Female; D006801:Humans; D006929:Hyperaldosteronism / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000601:surgery; D006965:Hyperplasia; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed; D014680:Veins; D055815:Young Adult
chemical_list: D000450:Aldosterone
keywords: Conn's syndrome; Primary aldosteronism; adrenal venous sampling; laparoscopic adrenalectomy