Endocrine Abstracts

JOINT345

Introduction: Primary hyperaldosteronism (PAH) causes secondary arterial hypertension. It requires high clinical suspicion and a hormonal study to confirm hypersecretion. To start an adequate treatment after confirming the diagnosis, it is necessary to demonstrate whether the hormonal hypersecretion is unilateral (surgical treatment) or bilateral (pharmacological treatment).

Objectives: In our Hospital we have endocrinology, interventional radiology and surgery specialized in adrenal pathology to evaluate complex hyperaldosteronism cases and agree on the best diagnostic-therapeutic approach. We collect our experience in adrenal venous catheterization, the gold standard for the study of PAH.

Material and Methods: Retrospective observational study carried out at the Málaga Regional University Hospital on outpatients who underwent adrenal vein catheterization over a period of 8 years (2016-2024). We collected clinical variables, laboratory tests, imaging tests and treatment.

Results: Nine subjects were included, 66.6% women, mean age 53 (35-67) years. Most of them had hypertension, hypokalemia or incidentaloma. All of them had elevated aldosterone/renin ratio. In 5 patients the confirmatory test was captopril test and in 2 patients a saline overload test was performed (as a first test or second test in case of inconclusive captopril test) and in 3 cases no confirmatory test was performed. All of them had S/C adrenal Tc: left nodule (66.6%), right nodule (22.2%) and bilateral nodule (11.1%). To clarify the case, MRI was performed in 4 patients (2 adenomas, 1 non-adenoma criteria and another without nodules) and scintigraphy in 8 cases, most without uptake and 1 discordant (in the 3 confirmed PAHs the gamma coincided with CT in 1 case). Adrenal venous catheterization confirmed lateralization in 3 patients (2 left and 1 right) coinciding with CT findings, 1 without lateralization and 5 inconclusive/valid due to not having correctly catheterized the right adrenal vein or due to taking spironolactone. Surgical treatment (unilateral adrenalectomy) was performed in 2 of the 3 cases confirmed with catheterization. In the third PAH confirmed by catheterization, surgery was not performed due to splenorenal shunt seen on CT. 6 patients receive medical treatment with good control of BP levels.

Conclusions: Catheterization is a fundamental technique for the study and treatment of PAH. It helps with hormonal studies and imaging tests, allowing for greater precision, performing adrenalectomy in cases with clear hyperaldosteronism secondary to unilateral secretion. We need a multidisciplinary team with endocrinologists, surgeons and interventional radiology with experience in performing it.