Accuracy of adrenal computed tomography in predicting the unilateral subtype in young patients with hypokalaemia and elevation of aldosterone in primary aldosteronism

Abstract

Primary aldosteronism patients aged <35 years with hypokalaemia and elevation of aldosterone and unilateral disease on adrenal CT could be spared AVS.

Diagnosis and treatment of primary aldosteronism: practical clinical perspectives

“…In this small number of patients, 68 Ga-pentixafor localized to the APAs [92]. Further studies will determine whether 68 Ga-pentixafor has clinically acceptable sensitivity and specificity for the detection of APAs. Finally, in vitro and animal studies have shown a high selectivity of a 18 F-PET imaging molecule (CDP2230) for CYP11B2 versus CYP11B1 with a favourable biodistribution for imaging CYP11B2 [93].…”

“…correlates with the expression of CYP11B2 (aldosterone synthase) [92]. The specific CXCR4 ligand 68 Ga-pentixafor was used as a PET imaging molecule in nine patients with PA due to APAs. In this small number of patients, 68 Ga-pentixafor localized to the APAs [92].…”

“…The specific CXCR4 ligand 68 Ga-pentixafor was used as a PET imaging molecule in nine patients with PA due to APAs. In this small number of patients, 68 Ga-pentixafor localized to the APAs [92]. Further studies will determine whether 68 Ga-pentixafor has clinically acceptable sensitivity and specificity for the detection of APAs.…”

Computed Tomography and Adrenal Venous Sampling in the Diagnosis of Unilateral Primary Aldosteronism

“…The overall discordance between CT and AVS results we report is highly similar to that of a systematic review (36% versus 38%) albeit the incidence of potential adrenalectomies on the wrong side in our study is lower (2% versus 4%), a difference that may be accounted for by the availability of follow-up data in all patients in our study and the inclusion of only patients with confirmed PA. 25 Despite the high level of discordance, we show in a cohort of 60 young patients (aged <35 years) that CT scanning combined with predictors based on young age and phenotype is a reliable approach to bypass AVS as recommended by the ES guideline 6 and in agreement with a study performed in Japan. 33 Limitations include the retrospective design and the potential for selection bias, the use of criteria for lateralization by CT that was not rigidly defined and office blood pressure measurements that were standard practice during much of the study period of patient evaluation. This may help to explain why the major differences between the CT and AVS cohorts reported herein were not defined by blood pressure measurements but by biochemical parameters.…”

MANAGEMENT OF ENDOCRINE DISEASE: Diagnosis and management of primary aldosteronism: the Endocrine Society guideline 2016 revisited

“…Patients with PA have an increased risk of cardiovascular and cerebrovascular events and target organ damage (heart and kidney) relative to patients with essential hypertension and a matched cardiovascular risk profile (4,5,6,7) or compared with the general population with hypertension (8). Patients with PA also display an increased prevalence of metabolic syndrome and diabetes (4,9,10,11), osteoporotic fractures (12) and symptoms of depression with a reduced quality of life (13,14). Some of these comorbidities may be associated with cortisol co-secretion (15).…”