Endocrine Abstracts

Background: Subtyping of primary aldosteronism (PA) using imaging and adrenal vein sampling (AVS) can yield discordant results. Varying interpretation criteria in determining AVS lateralization may affect discordance rates.Methods: We identified 337 consecutive patients with PA who underwent AVS at a quaternary care centre between August 2006 and February 2018. Patient demographics, laboratory results, diagnostic imaging, AVS results, and pathology were ...

Background: Negative imaging in the work-up for unilateral (surgical) primary aldosteronism (PA) presents a diagnostic dilemma. Clinicians may assume bilateral disease and treat medically or may proceed to adrenal vein sampling (AVS) to try to localize a unilateral source of aldosterone secretion. However, AVS is not without cost, risk, and limited access. We describe AVS results among imaging-negative PA patients.Methods: We identified 96 patients with ...

Unilateral forms of primary aldosteronism (PA) should, by inference, have a contralaterally normal and therefore suppressed adrenal zona glomerulosa. However, there is no agreed definition of expected adrenal suppression. We hypothesized two biochemical definitions of adrenal suppression based upon measurements done during adrenal vein sampling. These were then applied to a PA–AVS-outcomes database to determine whether either definition proved useful for interpretation of...

Introduction: We present a case of primary aldosteronism (PA) with adrenal mass, where lateralization of aldosterone production by adrenal-vein sampling (AVS) was discordant with cross-sectional imaging. We highlight an approach to investigation of PA using functional nuclear imaging, and show that subclinical cortisol excess may impact the reliability of AVS.Case: 70 year old female with 2.6 cm left-sided adrenal mass, ...

Background: Primary aldosteronism (PA) accounts for a significant proportion of patients with hypertension. There has been a focus on ACTH in the pathogenesis of aldosterone secretion even with suppressed renin. With the link between psychological stress and cardiovascular disease as well as the association between anxiety and PA, there may be broader neurohormonal “stress” stimuli that modulate aldosterone production in PA patients, beyond the HPA axis. PA patients ...

Background: Primary aldosteronism (PA) accounts for a significant proportion of patients with hypertension. There has been a focus on ACTH in the pathogenesis of aldosterone secretion even with suppressed renin. With the link between psychological stress and cardiovascular disease as well as the association between anxiety and PA, there may be broader neurohormonal “stress” stimuli that modulate aldosterone production in PA patients, beyond the HPA axis. PA patients ...

Introduction: Adrenal vein sampling (AVS) is considered gold-standard for diagnosis of unilateral primary aldosteronism (PA), and necessary pre-surgery. Imaging-AVS discordance may occur in up to 30-40% of PA-AVS series, and presents a diagnostic dilemma which may preclude surgery. Lateralization by AVS is defined as the ratio of aldosterone concentrations normalized by cortisol from each adrenal vein, and is thus sensitive to any pathologic asymmetry in corti...