Endocrine Abstracts

JOINT1636

Introduction: In primary hyperaldosteronism (PH), differentiating between unilateral and bilateral secretion is essential for defining treatment. Adrenal-CT imaging has limitations to determine subtype classification and lateralization, being adrenal venous sampling (AVS) the current test of choice. In this study, we aim to analyse, in our series, the degree of concordance between adrenal CT and AVS at stablishing subtype classification and lateralization in PH, as well as biochemical remission followed by adrenal-CT or AVS-guided adrenalectomy.

Materials and methods: A retrospective observational study of a cohort of patients with PH who underwent AVS with or without ACTH stimulation. Clinical, analytical, radiological data, AVS results, and biochemical success parameters according to PASO criteria were collected.

Results: Out of 69 patients, 38 underwent AVS, with a mean age of 54.4 years (S.D. ±8), 76.3% male. Median follow-up post-adrenalectomy was 5 months (IQR 3–10). Concordance was observed between AVS and CT in the subtype classification in 12 (31.5%) of the 38 patients (P=0.006). Adrenalectomy was performed in 27 patients, 19 of whom had both AVS and CT (one patient was excluded due to loss of follow-up). Biochemical cure was reached in 14 (77.7%) patients with AVS-guided adrenalectomy, with a correlation between CT and AVS in 8 of them (57.1%, P=0.007). Out of 8 patients with CT-guided adrenalectomy, 6 (75%) achieved biochemical remission, with a mean age at the time of surgery of 54.8 years, and the relation between lateralization by CT and biochemical cure was statistically significant (P<0.001).

Conclusions: The correlation of adequate lateralization between adrenal-CT and AVS observed in our series aligns with current literature: less than 40% of adrenal-CT results agree with AVS in subtype classification, and approximately only 50% show correct lateralization guided by CT compared with AVS. A high rate of biochemical remission was observed in those who underwent CT-guided adrenalectomy, despite a median age of 54.8 years. This could be explained by the fact that these were mostly patients with marked PH and unilateral image on CT.