Elsevier

Surgery

Volume 144, Issue 6, December 2008, Pages 926-933
Surgery

American Association of Endocrine Surgeon
The role of radiologic studies in the evaluation and management of primary hyperaldosteronism

https://doi.org/10.1016/j.surg.2008.07.025Get rights and content

Background

Surgical treatment of primary hyperaldosteronism (PHA) requires demonstration of unilateral adrenal hypersecretion. Optimal methods for interpretation of imaging and invasive testing are still in development.

Methods

A retrospective review from 1996–2007 of 106 patients with PHA was undertaken. Patient demographics, biochemical studies, radiologic imaging, operative reports, and pathology were reviewed and comparisons made. Optimal ratios for adrenal vein sampling were tested with regard to sensitivity and specificity. Preoperative and postoperative medication requirements and blood pressures were compared among different treatment groups.

Results

Seventy-eight patients (62 surgically treated) met criteria for inclusion. Median arterial blood pressure at diagnosis was 150/86 mm Hg while taking 3 antihypertensive medications. 69.2% required potassium supplementation. Median aldosterone:renin ratio was 107.0. Forty-two AVS procedures changed the management of 15 patients (35.7%) when compared to CT results. AVS accuracy was 96.6 vs 88.9% for NP-59 scintigraphy. Operative patients remained on fewer antihypertensive medications (1 vs 3), and mean systolic pressure was lower (130 vs 146 mm Hg) compared with medically managed patients.

Conclusion

When used together, pre-ACTH aldosterone ratios, normalized A/C:A/C ratios, ratios to define contralateral suppression, and post-ACTH stimulated values allowed for capture of episodically secreting tumors and subtle unilateral or bilateral hyperaldosteronism.

Section snippets

Patients

The records of 106 patients treated for biochemically confirmed PHA from February 1996 through October 2007 were reviewed in a retrospective manner after IRB approval. Patients were considered to have PHA in the setting of an elevated aldosterone level with an ARR of at least 20:1. In patients with equivocal diagnoses, additional testing, such as the SST, was employed. Seventy-eight patients (mean age, 50 years; range, 30–79; 44 men) had sufficient data for analysis. Patient demographics,

Results

Seventy-eight patients with PHA underwent CT scan, 45 (57.7%) underwent adrenal vein sampling (AVS), and 29 (37.2%) underwent NP-59 scintigraphy. Patient demographic information can be viewed in Table II.

Discussion

In recent years, there has been a resurgence of interest surrounding the adverse effects of aldosterone.1 Aldosterone has been found to be involved not only in severe and recalcitrant hypertension, but is also responsible for adverse cardiac and renal effects due to perivascular inflammatory changes.3, 4 Excess aldosterone levels have also been associated with the metabolic syndrome.5 Some postulate that tissues other than the adrenal gland, such as the brain and cardiac tissue, can produce

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