Endocrine Abstracts

Introduction: There is ongoing debate about how to diagnose and treat unilateral primary hyperaldosteronism (PA). The use of CT scans and adrenal venous sampling (AVS) for the diagnosis of unilateral PA leading to unilateral adrenalectomy is still a matter of discussion. Moreover, some have suggested subtotal adrenalectomy when a detectable nodule is found on imaging studies while others prefer total adrenalectomy. We gathered information on imaging, diagnosis and treatment in Icelandic PA subjects.

Methods: A retrospective chart review was performed of all patients (age 18 and older) diagnosed with PA during 2007–2011 at the Landspitali University Hospital in Iceland, a referral center for the whole country (population of 318.000). All patients were diagnosed using the same standardized methods. After pharmacological modification, screening and verification testing, with salt loading and positional tests, all patients where further examined with a CT scan and AVS. When AVS indicated unilateral disease, patients were offered a laparoscopic total adrenalectomy.

Results: Of the 33 patients diagnosed with PA, 17 patients had bilateral disease and 16 patients unilateral. All 16 patients with unilateral disease had an adrenalectomy. Histopathology (HP) found 11 patients with cortical adenomas and 4 with hyperplasia. HP was inconclusive in one patient. Three patients with bilateral disease had a unilateral nodule on CT scans. Three of the patients with an adenoma did not have a nodule on a CT scan. One of the patients that had unilateral hyperplasia had a nodule on a CT scan. In the case that HP was inconclusive a nodule was described on a CT scan.

Conclusion: Adrenal venous sampling is mandatory in diagnosing unilateral PA and CT is not only unreliable but can be misleading in that matter. These results indicate that a total adrenalectomy is a favorable treatment option for unilateral PA.