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Endocrine Abstracts (2018) 56 OC5.1 | DOI: 10.1530/endoabs.56.OC5.1

ECE2018 Oral Communications Diving deep into adrenal cortex diseases (5 abstracts)

Is adrenal computed tomography accurate for the diagnosis of unilateral primary aldosteronism? A retrospective international cohort study

Tracy Ann Williams 1, & Martin Reincke 1


1Ludwig-Maximilians-University, Munich, Germany; 2University of Turin, Turin, Italy.


Background: Unilateral primary aldosteronism is the most common surgically correctable form of endocrine hypertension, usually diagnosed by adrenal vein sampling (AVS) or computed tomography (CT). We compared the outcomes of patients diagnosed by CT and AVS and determined if CT can reliably diagnose unilateral primary aldosteronism in young patients with an evident phenotype.

Methods: Patient data were obtained from 18 internationally distributed centres over 4 continents from January 1994 to June 2016. Data were retrospectively analysed for clinical and biochemical outcomes after unilateral adrenalectomy from CT (n=235 patients) or AVS (n=526 patients) management using the standardised PASO (primary aldosteronism surgical outcome) criteria.

Findings: A smaller proportion of patients achieved complete biochemical success (cure of primary aldosteronism) with CT compared with AVS management (80.0% vs 93.3%, P<0.001). Absent biochemical success was present in 12.3 and 1.9% of patients in the CT and AVS groups, respectively (P<0.001). A diagnosis by CT was associated with a decreased likelihood of complete biochemical success (adjusted OR 0.28, 0.16–0.50; P<0.001). The clinical outcomes between the CT and AVS groups were not significantly different but the absence of a post-surgical elevated aldosterone-to-renin ratio was a marker of complete clinical success (adjusted OR 14.8, 1.76–124.53; P=0.013) and of clinical benefit (complete + partial clinical success) (adjusted OR 45.5, 11.63–177.93; P<0.001) in the CT but not in the AVS group. In the CT group there were 11 patients aged <35 years with a single unilateral nodule (>10 mm diametre) and a normal contralateral gland. Absent or partial biochemical success (persisting primary aldosteronism) was present in three of these 11 patients and all three had baseline plasma aldosterone concentrations >554.8 pmol/l (20 ng/dl).

Interpretation: Patients with CT management for unilateral primary aldosteronism have an increased likelihood of an incorrect diagnosis (compared with AVS) and misdiagnosis can occur in young patients with a strong phenotype. Inappropriate aldosterone production driven by CT based surgery is associated with absent clinical outcomes. This supports the recommendation to perform AVS in all patients with primary aldosteronism independent of age and phenotype.

Volume 56

20th European Congress of Endocrinology

Barcelona, Spain
19 May 2018 - 22 May 2018

European Society of Endocrinology 

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