Computed tomography combined with confirmatory tests for the diagnosis of aldosterone-producing adenoma

Abstract

Primary aldosteronism (PA) is the most common cause of secondary hypertension, and a simpler non-invasive method for identification of aldosterone-producing adenoma (APA) is required to improve the standard of medical treatment for PA patients. We retrospectively analyzed the clinical data of hypertensive patients with an aldosterone/renin ratio (ARR) ≥30 (ng/dL)/(ng/mL/h), and surgical and/or adrenal venous sampling (AVS) results served as the gold standard for APA diagnosis. The study aimed to determine whether positive CCT and SIT results plus a unilateral adrenal nodule found by CT allow unambiguous identification of an APA with high diagnostic specificity. Clinical data from 71 APA and 47 non-APA patients were collected, and logistic regression analysis was performed to construct models. Receiver operating characteristic (ROC) curves were used to analyze the efficacy of diagnostic tests. The areas under the ROC curves (AUCs) were similar between the post-SIT plasma aldosterone concentration (PAC) and post-CCT PAC (p > 0.05). The optimal post-SIT and post-CCT PAC cutoff values were 17.2 and 21.2 ng/dL, respectively. Positive CT findings combined with a post-SIT PAC >17.2 ng/dL or post-CCT PAC >21.2 ng/dL provided specificities of 97.8% and 95.7% for predicting APA, respectively. Logistic diagnostic models 1 (M1, CT finding + post-SIT PAC) and 2 (M2, CT finding + post-CCT PAC) were built, which showed equivalent diagnostic value (AUC = 0.959 and 0.932, respectively) (p > 0.05). The models combining CT findings with post-SIT PACs or post-CCT PACs represent an easier method to distinguish APA patients from other hypertensive patients with positive upright ARR results, especially in primary care where AVS may be unavailable.

Dual-energy spectral detector computed tomography differential diagnosis of adrenal adenoma and pheochromocytoma: Changes in the energy level curve, a phenomenon caused by lipid components?

“…Adrenal lesions are usually difficult to distinguish on imaging and need to be identified in combination with clinical examination indicators (5,6). Some studies even show that CT may mislead endocrinologists in the diagnosis of adenomas and propose that adrenal vein sampling is the gold standard for the diagnosis of adrenal lesions (7).…”

Lethal Arrhythmia Induced by Severe Hypokalemia with Primary Aldosteronism: A Case Report and Literature Review

“…The causes of severe hypokalemia in our patient potentially include (i) remarkably large amounts of aldosterone and thus a marked excess in urinary potassium excretion; (ii) a KCNJ5 gene mutation in the adrenal tumor; and/or (iii) her low vegetable intake due to an unbalanced diet. In terms of the first point, the mean serum potassium and median ARR of patients with APA are reported to be 3.26 mEq/L and 1,390 (pg/mL)/(ng/mL/h), respectively (with PAC measured using an RIA) (34); in the present patient, these parameters were 2.0 mEq/L and 2,160 (pg/mL)/(ng/ mL/h), respectively, with the PAC represented by an RIAequivalent value. Since excess aldosterone increased the activity of the sodium/potassium pump in the distal tubules and collecting ducts, thereby promoting the urinary excretion of potassium, hyperaldosteronism appeared to be the etiology of her severe hypokalemia.…”

The problem of timely diagnosis of primary hyperaldosteronism. Clinical case

“…ЕКГ: синусовий ритм, ЧСС 78 за 1 хв, АВ-блокада І ст., гіпертрофія лівих відділів серця, ознаки гіпокаліємії. Оптимальним методом, що демонструє високу чутливість і специфічність візуалізації надниркових залоз, є КТ [11]. Більшість аденом локалізується лише в одному наднирнику, і аденома має вигляд одиничного вузлового утворення однорідної інтенсивності з чітким контуром.…”