Primary hyperaldosteronism: comparison of CT, adrenal venography, and venous sampling

Geisinger, MA; Zelch, MG; Bravo, E L; Risius, BF; O'Donovan, P B; Borkowski, GP

doi:10.2214/ajr.141.2.299

Cited by 78 publications

(11 citation statements)

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“…Adrenocortical adenomas (Conn's tumour) are usually small with a mean size of 1.6-1.8 cm [6,7], although approximately 15-20 % of aldosteronomas are micronodules measuring less than 1 cm [8]. On CT they tend to be of low density (0-10 Hounsfield units) (Fig.…”

Section: Adrenal Hyperfunctionmentioning

confidence: 99%

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State-of-the-art CT and MRI of the adrenal gland

Peppercorn

Reznek

1997

Eur Radiol

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Both CT and MRI have achieved high accuracy in the investigation of patients suspected of having adrenal pathology. The choice of technique will depend on several factors discussed in the review. The advent of spiral CT has allowed the examination to be tailored to demonstrating the adrenal with very high spatial resolution and it remains the most widely used initial technique. This review concentrates on new techniques for evaluating the incidentally discovered adrenal mass and differentiating between adrenal adenomas and metastases.

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Section: Adrenal Hyperfunctionmentioning

confidence: 99%

“…Reported sensitivities of CT in detecting adenomas range from 58 % to 88 % [6,7,9]. Few studies have compared CTwith MRI.…”

Section: Adrenal Hyperfunctionmentioning

confidence: 99%

State-of-the-art CT and MRI of the adrenal gland

Peppercorn

Reznek

1997

Eur Radiol

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“…Although widely used thereafter (1,(11)(12)(13)(14)(15)(16), the usefulness of adrenal vein catheterization has been challenged in recent years by the advent of tests with unprecedented accuracy for imaging adrenocortical diseases, such as computed tomography (CT) and magnetic resonance (MR) (12,17). This led to the abandonment of adrenal phlebography, because of its low sensitivity coupled to a substantial risk of adrenal vein rupture (18), whereas adrenal vein blood sampling (AVS) was confined to cases with inconclusive CT and/or MR results to demonstrate a unilateral source of aldosterone excess (16).…”

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confidence: 99%

Identification of the Etiology of Primary Aldosteronism with Adrenal Vein Sampling in Patients with Equivocal Computed Tomography and Magnetic Resonance Findings: Results in 104 Consecutive Cases

Rossi

Sacchetto

Chiesura-Corona

et al. 2001

The Journal of Clinical Endocrinology & Metabolism

224

135

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The objectives of this study were to investigate the usefulness of adrenal vein sampling in identifying the etiology of primary aldosteronism (PA) in patients with equivocal CT and MR findings. Between 1990 and 1999, 104 referred hypertensive patients (45 women and 59 men, aged 49.6 +/- 11.6 yr) were diagnosed to have PA with inconclusive computed tomography scan and magnetic resonance results, based on established criteria. Adrenal vein sampling (AVS) for measurement of plasma aldosterone (A) and cortisol (C) levels was performed in all. Selectivity of AVS was assessed by the ratio between C levels in each adrenal vein and in the infrarenal inferior vena cava plasma (C(side)/C(IVC)). A receiver operator characteristics analysis was carried out to establish 1) the best AVS-derived index, 2) the degree of selectivity that could provide an accurate diagnosis, and 3) whether a correct diagnosis could be made from a unilaterally selective AVS. An aldosterone-producing adenoma (average diameter, 12.2 +/- 0.08 mm) was eventually diagnosed in 41 patients (39.4%) and was excluded in the rest. Adrenal vein rupture leading to partial adrenal loss occurred in 1 patient (0.9% complication rate). By assuming a cut-off value of C(side)/C(IVC) > or = 1.1, AVS was selective in 85.7% and 94.1% of cases on the right and left sides, respectively, and bilaterally in 80.6% of cases. Of all AVS-derived indexes, the A/C of one over the A/C contralateral side [(A/C)(side)/(A/C)(contralateral side)] furnished the best diagnostic accuracy. With a bilaterally selective AVS, a value of (A/C)(side)/(A/C)(contralateral side) > or = 2 provided a conclusive etiological diagnosis of PA in 79.7% of cases. At variance, no accurate diagnosis could be made from unilaterally selective AVS. AVS was feasible and safe in most PA patients with inconclusive computed tomography and magnetic resonance scans. When bilaterally selective (i.e. C(side)/C(IVC) > or = 1.1) a ratio of (A/C)(side)/(A/C)(control) > or = 2 provided the best compromise of sensitivity and false positive rate for lateralization of the etiology of PA.

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“…Other groups have reported the sensitivity of CT to be about 70% v 92% to 96% for AVS. 13,20 Given the potential for misdiagnosis of PA subtype and the implications of incorrect management or surgery, we advocate AVS as a routine study in patients with PA who are being considered for surgical intervention.…”

Section: Discussionmentioning

confidence: 99%