Endocrine Abstracts

Primary aldosteronism is the most common form of secondary hypertension. The detection of primary aldosteronism is of particular importance, because it provides an opportunity for a targeted treatment (surgical for unilateral forms and medical with mineralocorticoid receptor antagonists for bilateral forms). PA diagnosis comprises screening, confirmation testing and subtype diagnosis.

Guidelines recommend that all patients for whom the surgical treatment is practicable and desired should undergo adrenal vein sampling (AVS) as the gold standard to differentiate unilateral from bilateral adrenal disease. AVS is technically difficult, especially in terms of successful cannulation of the right adrenal vein and the success rate increases with experience and dedication of the radiologist. The introduction of a method for real-time rapid cortisol assay during AVS, which provides the radiologist of information on the success of the cannulation, offers a new tool to improve the performance of AVS. We recently assessed the impact of differing criteria for successful cannulation and lateralization on reproducibility of subtype diagnosis and also the effect of ACTH stimulation. The use of permissive cannulation success criteria can lead to significant numbers of patients being given a definitive subtype diagnosis when stricter criteria would have led to the study results being rejected or interpreted with great caution; unfortunately, permissive criteria are associated with a low reproducibility of the diagnosis. Furthermore, we showed that ACTH infusion may be of help for those centers with a low rate of cannulation and perform at least as well as the unstimulated protocol for final diagnosis of PA subtypes. The possibility of performing adrenalectomy in some selected PA patients without AVS and the necessity of having contralateral suppression of the aldosterone secretion from the adrenals, is still a matter of discussion.