Endocrine Abstracts

Relevance: Due to numerous causes of PA, AVS allows differentiating variant nosological forms of PA. The importance of differential diagnosis is due to the fact that surgery is reasonable only with unilateral variant of PA, while in idiopathic hyperaldosteronism surgery isn’t a method of choice.

Purpose: To assess the diagnostic possibilities of using AVS against the background of endogenous stimulation of adrenocorticotropic hormone (ACTH) in the early morning hours for choosing the method of treatment of PA.

Materials and methods: Fourty-eight patients were prospectively enrolled for AVS, average age 40y.o. (2011–2017), with arterial hypertension, adrenal glands lesion according to CT and laboratory confirmed PA (elevated aldosterone-renin ratio and postinfusion level of aldosterone). Average size of lesion was 2 cm (1.5–3), density from −1 to +10HU, and with bilateral damage, the second gland was hyperplastic (about 10mm). We measured reliable level of selectivity gradient as 3:1, then we calculated the result of lateralization gradient, and more than 2 shows unilateral aldosterone production, less than 2 shows bilateral aldosterone production.

Results: According to CT, unilateral macrogyperplasia was detected in 13 patients (27% of total), all of them were confirmed to have unilateral hyperproduction of aldosterone according to AVS. Unilateral microhyperplasia was detected in 12 patients (25%); among them 4 (8.3% of total) was confirmed unilateral hyperproduction according to AVS. It was detected that bilateral macrogyperplasia was in 23 patients (48%), of which 6 patients (12.5% of total) showed bilateral hypersecretion of aldosterone.

Conclusion: CT didn’t correspond with the results of AVS in 4.1% cases. In absence of AVS, surgery in these patients wouldn’t have been implemented. In 20% cases was identify bilateral hyperproduction and relying only on CT, adrenalectomy could be done unreasonable. Given our data, it can be concluded that AVS is an important step in the differential diagnosis of PA.