This Article Full Text Full Text (PDF) Submit a related Letter to the Editor Purchase Article View Shopping Cart Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Copyright Permission Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Phillips, J. L. Articles by Gill, J. R. Search for Related Content PubMed PubMed Citation Articles by Phillips, J. L. Articles by Gill, J. R., Jr. Pubmed/NCBI databases Compound via MeSH Substance via MeSH

Predictive Value of Preoperative Tests in Discriminating Bilateral Adrenal Hyperplasia from an Aldosterone-Producing Adrenal Adenoma

Urologic Oncology Branch/National Cancer Institute (J.L.P., M.M.W., W.R., A.A.B., W.M.L.), Hypertension-Endocrine Branch/National Heart, Lung and Blood Institute (J.R.G.), and Department of Radiology/Walter Magnusson Clinical Center/National Institutes of Health (P.L.C., J.L.D.), Bethesda, Maryland 20892-1501; and Department of Pharmacology (J.C.P.), Georgetown University, Washington, DC

Address correspondence and requests for reprints to: John L. Phillips, M.D., Urologic Cancer Institute, National Cancer Institute, Building 10, Room 2B47, Bethesda, Maryland 20892-1501.

In primary hyperaldosteronism, discriminating bilateral adrenal hyperplasia (BAH) from an aldosterone-producing adenoma (APA) is important because adrenalectomy, which is usually curative in APA, is seldom effective in BAH. We analyzed the results from our most recent 7-yr series to evaluate the predictive value of preoperative noninvasive tests compared with adrenal vein sampling (AVS). Forty-eight patients with hypertensive hyperaldosteronism underwent bedside testing, computed tomography (CT) imaging, and AVS. Those in whom the results of AVS indicated APA underwent adrenalectomy. Twelve (30%) and 14 (34%) of 41 patients with APA had paradoxical falls with ambulation in plasma aldosterone concentration (PAC) and 18-hydroxycorticosterone (18-OH-B), respectively. Twenty-nine (70%) and 26 (65%) APA patients had a rise in PAC and 18-OH-B, respectively, as did all 8 BAH patients. Significant identifiers of BAH were supine PAC values less than 15 ng/dL (P = 0.04), an increase greater than 60% (P = 0.02) in PAC with ambulation, and supine 18-OH-B values less than 60 ng/dL (P = 0.04). CT imaging alone was not predictive for BAH or APA. In our population, patients with a positive bedside test result (e.g. a fall in PAC and/or 18-OH-B) and a unilateral adrenal nodule on CT (10 of 41 patients) could have proceeded directly to adrenalectomy for APA. However, a positive bedside test result with a negative CT or a negative bedside test result regardless of CT findings required AVS to confirm the diagnosis and site of disease.

This article has been cited by other articles:

				J. W. Funder, R. M. Carey, C. Fardella, C. E. Gomez-Sanchez, F. Mantero, M. Stowasser, W. F. Young Jr., and V. M. Montori Case Detection, Diagnosis, and Treatment of Patients with Primary Aldosteronism: An Endocrine Society Clinical Practice Guideline J. Clin. Endocrinol. Metab., September 1, 2008; 93(9): 3266 - 3281. [Abstract] [Full Text] [PDF]

				V.C. Wu, S.C. Chueh, H.W. Chang, W.C. Lin, K.L. Liu, H.Y. Li, Y.H. Lin, K.D. Wu, and B.S. Hsieh Bilateral aldosterone-producing adenomas: differentiation from bilateral adrenal hyperplasia QJM, January 1, 2008; 101(1): 13 - 22. [Abstract] [Full Text] [PDF]

				R. J. Auchus, D. W. Chandler, S. Singeetham, N. Chokshi, F. E. Nwariaku, B. L. Dolmatch, S. A. Holt, F. H. Wians Jr., S. C. Josephs, C. K. Trimmer, et al. Measurement of 18-Hydroxycorticosterone during Adrenal Vein Sampling for Primary Aldosteronism J. Clin. Endocrinol. Metab., July 1, 2007; 92(7): 2648 - 2651. [Abstract] [Full Text] [PDF]

				Authors/Task Force Members:, G. Mancia, G. De Backer, A. Dominiczak, R. Cifkova, R. Fagard, G. Germano, G. Grassi, A. M. Heagerty, S. E. Kjeldsen, et al. 2007 Guidelines for the Management of Arterial Hypertension: The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC) Eur. Heart J., June 11, 2007; (2007) ehm236v1. [Full Text] [PDF]

				N. Daunt Adrenal Vein Sampling: How to Make It Quick, Easy, and Successful RadioGraphics, October 1, 2005; 25(suppl_1): S143 - S158. [Abstract] [Full Text] [PDF]

				P.-F. Plouin, L. Amar, and G. Chatellier Trends in the prevalence of primary aldosteronism, aldosterone-producing adenomas, and surgically correctable aldosterone-dependent hypertension Nephrol. Dial. Transplant., April 1, 2004; 19(4): 774 - 777. [Full Text] [PDF]

				R. K. Lingam, S. A. Sohaib, I. Vlahos, A. G. Rockall, A. M. Isidori, J. P. Monson, A. Grossman, and R. H. Reznek CT of Primary Hyperaldosteronism (Conn's Syndrome): The Value of Measuring the Adrenal Gland Am. J. Roentgenol., September 1, 2003; 181(3): 843 - 849. [Abstract] [Full Text] [PDF]

				E. A. Espiner, D. G. Ross, T. G. Yandle, A. M. Richards, and P. J. Hunt Predicting Surgically Remedial Primary Aldosteronism: Role of Adrenal Scanning, Posture Testing, and Adrenal Vein Sampling J. Clin. Endocrinol. Metab., August 1, 2003; 88(8): 3637 - 3644. [Abstract] [Full Text] [PDF]

				A. Ganguly Distinguishing Unilateral Aldosteronoma from Bilateral Disease J. Clin. Endocrinol. Metab., August 1, 2001; 86(8): 4004 - 4005. [Full Text] [PDF]