Endocrine Abstracts

Overview: Discrepancies between adrenal imaging and adrenal vein sampling (AVS) are relatively common in primary hyperaldosteronism, occurring in 20-40% of cases. AVS is considered the gold standard for determining whether aldosterone overproduction is unilateral or bilateral, whereas CT/MRI is better for anatomical localization.

Case presentation: Screening tests showed elevated aldosterone (462) and suppressed renin (<0.1), suggesting primary hyperaldosteronism. A saline infusion confirmatory test revealed increased aldosterone (240) with a high aldosterone-to-renin ratio (ARR). Imaging showed a 4 cm left adrenal nodule without concerning features, and adrenal vein sampling indicated right-side dominance. A whole-body FDG PET CT confirmed no significant changes in size or activity of the left adrenal nodule. with a minimal cancer risk. Due to the challenges in obtaining a CETO PET scan and the absence of concerns from AVS (adrenal vein sampling) results, the patient underwent laparoscopic right adrenalectomy on November 13, 2024. All antihypertensive medications were discontinued postoperatively. The patient was discharged without complications and with follow-up arranged with the surgical team. Histological outcome showed a nodule measuring 8×9×6 mm, consistent with an adrenal cortical adenoma.

Discussion: Discrepancies between adrenal venous sampling (AVS) and imagines can complicate adrenal disorder diagnosis. AVS is more sensitive for localizing aldosterone production, while CT/MRI/ PET may miss hormonal activity due to metabolic factors. These differences can lead to conflicting results, highlighting the need to understand both methods to improve diagnostic accuracy and patient care.