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Noninvasive adrenal imaging in hyperaldosteronism: is it accurate for correctly identifying patients who should be selected for surgery?

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Abstract

Background and aims

The most common causes of hyperaldosteronism (HA) are bilateral idiopathic hyperaldosteronism (IHA), aldosterone-producing adenoma (APA), and unilateral primary adrenal hyperplasia (PAH). We evaluated if non-invasive preoperative imaging studies are able to reliably differentiate these causes of hyperaldosteronism.

Methods

The medical records of 50 consecutive patients with HA were reviewed. Follow up was obtained by outpatient consultation or phone contact.

Results

Thirty-five patients (70%) underwent successful adrenalectomy for APA, basing on the computed tomography (CT) scan results only. All these patients were biochemically cured. The remaining 15 patients underwent dexamethasone suppression adrenal cortical scintiscan (ACS) because of equivocal or inconclusive CT scan. In 11 of these patients, ACS showed a bilateral uptake, suggesting IHA. They were followed-up. In the remaining four patients, ACS showed a unilateral uptake. These patients underwent adrenalectomy. Final histology showed APA in three patients and PAH in one. They were biochemically cured. Sensitivity of combined non-invasive imaging procedures (CT and ACS) in detecting histologically proven and biochemically cured APA and PAH was 100%.

Conclusion

Non-invasive adrenal imaging studies are accurate in distinguishing between IHA and APA/PAH. Invasive diagnostic tests (adrenal venous sampling) should be indicated only when they do not conclusively localize hypersecretion.

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References

  1. Fiquet-Kempf B, Launay-Mignot P, Bobrie G, Plouin PF (2001) Is primary aldosteronism underdiagnosed in clinical practice? Clin Exp Pharmacol Physiol 28:1083–1086

    Article  PubMed  CAS  Google Scholar 

  2. Loh K, Koay E, Khaw M, Emmanuel SC, Young WF Jr (2000) Prevalence of primary hyperaldosteronism among Asian hypertensive patients in Singapore. J Clin Endocrinol Metab 85:2854–2859

    Article  PubMed  CAS  Google Scholar 

  3. Young WF (1999) Primary aldosteronism: a common and curable form of hypertension. Cardiol Rev 7:207–214

    Article  PubMed  Google Scholar 

  4. Stowasser M (2001) Primary aldosteronism: rare bird or common cause of secondary hypertension? Curr Hypertens Rep 3:230–239

    Article  PubMed  CAS  Google Scholar 

  5. Ganguly A (1998) Primary aldosteronism. N Engl J Med 339:1828–1834

    Article  PubMed  CAS  Google Scholar 

  6. Weinberger MH, Fineberg NS (1993) The diagnosis of primary aldosteronism and separation of two major subtypes. Arch Intern Med 153:2125–2129

    Article  PubMed  CAS  Google Scholar 

  7. Irony I, Kater CE, Biglieri EG (1990) Correctable subsets of primary aldosteronism: primary adrenal hyperplasia and renin responsive adenoma. Am J Hypertens 3:576–582

    PubMed  CAS  Google Scholar 

  8. Lim PO, Young MF, McDonald TM (2001) A review of the medical treatment of primary aldosteronism. J Hypertens 19:353–361

    Article  PubMed  CAS  Google Scholar 

  9. Young WF Jr (2002) Primary aldosteronism: management issues. Ann NY Acad Sci 970:61–76

    Article  PubMed  Google Scholar 

  10. Blumenfeld JD, Sealey JE, Schlussel Y, Vaughan ED Jr, Sos TA, Atlas SA, Muller FB, Acevedo R, Ulick S, Laragh J (1994) Diagnosis and treatment of primary aldosteronism. Ann Intern Med 121:877–885

    PubMed  CAS  Google Scholar 

  11. Tanabe A, Naruse M, Naruse K, Hase M, Yoshimoto T, Tanaka M, Seki T, Depura R, Depura H (1997) Left ventricular hypertrophy is more prominent in patients with primary aldosteronism that in patients with other types of secondary hypertension. Hypertens Res 20:85–90

    PubMed  CAS  Google Scholar 

  12. Rossi GP, Sacchetto A, Pavan E, Palatini P, Granierto GR, Canali C, Pessina AC (1997) Remodeling of the left vetricle in primary aldosteronism due to Conn’s adenoma. Circulation 95:1471–1478

    PubMed  CAS  Google Scholar 

  13. Magill SB (2001) Adrenal vein sampling: an overview. Endocrinologist 11:357–363

    Google Scholar 

  14. Phillips JL, Walther MM, Pezzullo JC, Rayford W, Choike PL, Berman AA, Linehan WM, Doppman JL, Gill JR (2000) Predictive value of preoperative tests in discriminating bilateral adrenal hyperplasia from an aldosterone–producing adrenal adenoma. J Clin Endocrinol Metab 85:4526–4533

    Article  PubMed  CAS  Google Scholar 

  15. Young WF, Stanson AW, Thompson GB, Grant CS, Farley DR, van Heerden JA (2004) Role of adrenal venous sampling in primary aldosteronism. Surgery 136:1227–1235

    Article  PubMed  Google Scholar 

  16. Lim PO, Rodgers P, Cardale K, Watson AD, MacDonald TM (1999) Potentially high prevalence of primary aldosteronism in a primary-care population. Lancet 353:40

    Article  PubMed  CAS  Google Scholar 

  17. Mulatero P, Stowasser M, Loh KC, Fardella CE, Gordon RD, Mosso L, Gomez-Sanchez CE, Veglio F, Young WF (2004) Increased diagnosis of primary aldosteronism, including surgically correctable forms, in centers from five continents. J Clin Endocrinol Metab 89:1045–1050

    Article  PubMed  CAS  Google Scholar 

  18. Sawka AM, Young WF, Thompson GB, Grant CS, Farley DR, Leibson C, van Heerden JA (2001) Primary aldosteronism: factors associated with normalization of blood pressure after surgery. Ann Intern Med 135:258–261

    PubMed  CAS  Google Scholar 

  19. Gross MD, Shapiro B, Grekin RJ, Freitas JE, Glazer G, Beierwaltes WH, Thompson NW (1984) Scintigraphic localization of adrenal lesions in primary aldosteronism. Am J Med 77:839–844

    Article  PubMed  CAS  Google Scholar 

  20. Lumachi F, Marzola MC, Zucchetta P, Tregnaghi A, Cecchin D, Favia G, Bui F (2003) Non-invasive adrenal imaging in primary aldosteronism. Sensitivity and positive predictive value of radiocholesterol scintigraphy, CT scan and MRI. Nucl Med Common 24:683–688

    Article  CAS  Google Scholar 

  21. Kloos RT, Gross MD, Francis IR, Korobkin M, Shapiro B (1995) Incidentally discovered adrenal masses. Endocr Rev 16:460–484

    Article  PubMed  CAS  Google Scholar 

  22. Melby JC, Spark RF, Dale SL, Egdahl RH, Kahn PC (1967) Diagnosis and localization of aldosterone-producing adenomas by adrenal-vein catheterization. N Engl J Med 277:1050–1056

    Article  PubMed  CAS  Google Scholar 

  23. Doppman JL, Gill JRr (1996) Hyperaldosteronism: sampling the adrenal vein. Radiology 198:309–312

    PubMed  CAS  Google Scholar 

  24. Rossi GP, Sacchetto A, Chiesura-Corona M, De Toni R, Gallina M, Feltrin GP, Pessina AC (2001) Identification of the etiology of primary aldosteronism with adrenal vein sampling in patients with equivocal computed tomography and magnetic resonance findings: results in 104 consecutive cases. J Clin Endocrinol Metab 86:1083–1090

    Article  PubMed  CAS  Google Scholar 

  25. Novitsky YW, Kercher KW, Rosen MJ, Cobb WS, Jyothinagaram S, Heniford BT (2005) Clinical outcomes of laparoscopic adrenalectomy for lateralizing nodular hyperplasia. Surgery 138:1009–1017

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Divisione di Endocrinochirurgia, Istituto di Clinica Chirurgica, Università Cattolica del Sacro Cuore, Largo A. Gemelli, 8, 00168, Rome, Italy

    Celestino Pio Lombardi, Marco Raffaelli, Carmela De Crea & Rocco Bellantone

  2. Institute of Nuclear Medicine, Università Cattolica del S. Cuore, Rome, Italy

    Vittoria Rufini & Giorgio Treglia

Authors
  1. Celestino Pio Lombardi
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  2. Marco Raffaelli
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  3. Carmela De Crea
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  4. Vittoria Rufini
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  5. Giorgio Treglia
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  6. Rocco Bellantone
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Corresponding author

Correspondence to Marco Raffaelli.

Additional information

This paper is based on a work that has been presented as oral presentation at the 2nd Biennal ESES Congress, May 2006, Krakow, Poland.

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Lombardi, C.P., Raffaelli, M., De Crea, C. et al. Noninvasive adrenal imaging in hyperaldosteronism: is it accurate for correctly identifying patients who should be selected for surgery?. Langenbecks Arch Surg 392, 623–628 (2007). https://doi.org/10.1007/s00423-006-0137-2

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  • DOI: https://doi.org/10.1007/s00423-006-0137-2

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