Diagnostic performance of CT versus MR in detecting aldosterone-producing adenoma in primary hyperaldosteronism (Conn?s syndrome)

Lingam, Ravi Kumar; Sohaib, S.A.; Rockall, Andrea; Isidori, Andrea M.; Chew, Shern L.; Monson, John P.; Grossman, Ashley; Besser, G. M.; Reznek, Rodney H.

doi:10.1007/s00330-004-2308-2

Cited by 43 publications

(18 citation statements)

References 12 publications

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“…The finding of a unilateral adrenal mass either on CT or MRI with a diameter O4 cm is suggestive of adrenal cortical carcinoma, especially in those patients without signs and symptoms of catecholamine, cortisol or aldosterone excess ; Table 1). The presence of necrosis, haemorrhage or calcification leans more to the diagnosis of carcinoma (Rockall et al 2004). On MRI examination, if the entire lesion loses signal on the out-of-phase images the mass is an adenoma.…”

Section: Differentiating Adenomas From Carcinomasmentioning

confidence: 99%

“…Other rare causes included collision tumours with adenomas and primary pigmented nodular adrenal dysplasia (PPNAD). In PPNAD, uni-or bilateral small (2-5 mm) adrenal nodules have been reported (Rockall et al 2004). There have also been reports of normal CT scans and a report of myeloid metaplasia of the nodules (with very high lipid content; Courcoutsakis et al 2004).…”

Section: Differentiating Hyperfunctioning From Non-functioning Lesionsmentioning

confidence: 99%

“…Cortical hyperplasia can be distinguished from focal tumours with sensitivity O95% using CT. In a study of 34 patients with primary hyperaldosteronism (17 due to bilateral adrenal hyperplasia and 17 due to adenomas), CT was shown to detect aldosteronomas with a sensitivity and specificity of 87 and 93% respectively (Lingam et al 2004). In patients with aldosteronomas, the adrenal glands may be normal, show minimal unilateral adrenal thickening, uni-or bilateral solitary or multiple adenomas (ranging in size from !1 to O1 cm; Young 2003).…”

Section: Differentiating Hyperfunctioning From Non-functioning Lesionsmentioning

confidence: 99%

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The optimal imaging of adrenal tumours: a comparison of different methods

Ilias

Sahdev²,

Reznek³

et al. 2007

Endocr Relat Cancer

235

162

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Computed tomography (CT; unenhanced, followed by contrast-enhanced examinations) is the cornerstone of imaging of adrenal tumours. Attenuation values of !10 Hounsfield units on an unenhanced CT are practically diagnostic for adenomas. When lesions cannot be characterised adequately with CT, magnetic resonance imaging (MRI) evaluation (with T1-and T2-weighted sequences and chemical shift and fat-suppression refinements) is sought.

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Section: Differentiating Adenomas From Carcinomasmentioning

confidence: 99%

Section: Differentiating Hyperfunctioning From Non-functioning Lesionsmentioning

confidence: 99%

Section: Differentiating Hyperfunctioning From Non-functioning Lesionsmentioning

confidence: 99%

See 1 more Smart Citation

The optimal imaging of adrenal tumours: a comparison of different methods

Ilias

Sahdev²,

Reznek³

et al. 2007

Endocr Relat Cancer

235

162

View full text Add to dashboard Cite

show abstract

“…However, there is a wide variation in the reported diagnostic performance of CT (sensitivity, 40% to 100%) and MRI (sensitivity, 70% to 100%) in detecting aldosterone-producing adenoma. 32,33 In patients with GRA or FH-II, the adrenal gland morphology with imaging techniques may be misleading. The glands do not necessarily appear normal.…”

Section: Confirmatory Testingmentioning

confidence: 99%

A Tale of Two Patients With Mendelian Hypertension

et al. 2008

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C onn emphasized the triad of hypertension, hypokalemia, and metabolic alkalosis in his seminal account of patients with primary aldosteronism. 1 He believed that primary aldosteronism was a very common cause of hypertension. Kaplan introduced the discussion as to the actual prevalence of primary aldosteronism, a topic still debated today. 2,3 Suffice it to say that hypokalemic hypertension is a fixed entity in the minds of clinicians as synonymous with primary aldosteronism, and perhaps this reaction is appropriate. Nonetheless, there are other diagnostic considerations. For instance, licorice gluttony looks exactly like primary aldosteronism clinically; the diagnosis requires a particularly high grade of detective work. 4 However, Mendelian disorders have become increasingly recognized, especially because elucidation of their molecular mechanisms provides reliable diagnostic tools. 5 Another confounder is the fact that contrary to prevailing clinical opinion, electrolyte and acid-base abnormalities are absent in many patients with primary aldosteronism. 6 We describe 2 remarkable patients who were clinical adventures for us and provided several important lessons. Case 1An 18-year-old male student was admitted for further evaluation of suspected primary aldosteronism. A routine examination at the age of 15 years revealed a blood pressure of 150/90 mm Hg; however, no further workup was done at that time and no therapeutic consequences were drawn. Three years later, the patient's concerned mother consulted a nephrologist. Family history revealed hypertension in his father and brother. At that time, a 24-hour ambulatory blood pressure measurement (ABPM) revealed an average 24 h blood pressure of 156/98 mm Hg without a nocturnal dip. The nephrologist's attention was drawn to a low potassium level (3.46 mmol/L). The plasma aldosterone concentration (PAC) was 580 pg/mL (normal range: 70 to 295 pg/mL; corresponding to 58 ng/dL or 1609 pmol/L). The conversion factor for aldosterone from ng/dL to SI units (nmol/L) is 0.0349. The plasma renin concentration (PRC) was 1.2 pg/mL (normal range: 3 to 33 pg/mL). The conversion factor for renin in pg/mL to SI units (pmol/L) is 0.0237. The value corresponds to PRA suppressed Ͻ0.1 ng/mL/h; conversion outlined elsewhere. 7 The aldosterone/renin ratio (ARR) was 472. Furthermore, the serum sodium concentration was elevated at 149 mmol/L. Renal function was normal, except for microalbuminuria of 61 mg/24 h (normal range Ͻ30 mg/24 h). Blood gas analysis revealed a compensated metabolic alkalosis. Two liters of 0.9% saline solution were infused, but failed to achieve sufficient PAC suppression (Ͻ50 pg/mL, Ͻ5 ng/dL). As a matter of fact, his PAC increased slightly. Magnetic resonance imaging (MRI) of the abdomen revealed an enlarged left adrenal gland with multiple small nodules (diameter 2 to 3 mm), which showed T2-weighted hyperintensity. The right adrenal gland appeared unremarkable. Unfortunately adrenal venous sampling (AVS) was unsuccessful, because only the left gland could be ca...

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“…However, these imaging tests have often been inconclusive for the diagnosis of PA subtype [8]. Discordant results between CT findings and definite PA subtype are mainly attributable to non-functioning adrenal tumor, small adrenal pathology, such as microadenoma and micronodules (less than 6 mm in size) not detectable even in thin-slice (3 mm) CT scan.…”

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confidence: 99%

Diagnostic Accuracy of Adrenal Venous Sampling in Comparison with Other Parameters in Primary Aldosteronism

et al. 2008

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Abstract. This retrospective study was aimed 1) to compare the difference of the findings between adrenal CT scan and adrenal venous sampling (AVS) in 35 cases with definite primary aldosteronism (PA) for assessment of the diagnostic efficacy of PA subgroup (unilateral and bilateral adrenal hypersecretion: UAH and BAH), and 2) to determine the clinical and biochemical parameters as potential predictors for PA subgroup. There were significant discordant results based on AVS and CT scan in subgrouping PA; 9 of 17 BAH patients (53%) had unilateral lesion on CT scan, while 4 of 18 UAH patients (22%) had no apparent or bilateral lesions on CT scan. Among three diagnostic criteria, absolute values of plasma aldosterone concentration (PAC) in both adrenal veins, lateralized and contralateral ratios of aldosterone/cortisol after ACTH stimulation during AVS to determine the laterality, none of them showed 100% diagnostic accuracy if applied alone. Among several clinical and biochemical parameters, hypokalemia (<3.4 mEq/l), younger age (<52 y) and poor response of PAC (<1.45) after furosemide-upright posture, proved to be significant predictors for UAH, with higher specificities (100%, 88%, 94%, respectively). Therefore, despite AVS as a gold standard method to determine the laterality of aldosterone hypersecretion in PA, our study shows that no single criterion could provide definite diagnostic value for its laterality by AVS. It is also suggested that most PA patients, if not all, with a distinct unilateral adrenal lesion on CT accompanied by hypokalemia, younger age and poor aldosterone response to renin stimulation, could undergo adrenalectomy without prior AVS.

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Diagnostic performance of CT versus MR in detecting aldosterone-producing adenoma in primary hyperaldosteronism (Conn?s syndrome)

Cited by 43 publications

References 12 publications

The optimal imaging of adrenal tumours: a comparison of different methods

The optimal imaging of adrenal tumours: a comparison of different methods

A Tale of Two Patients With Mendelian Hypertension

Diagnostic Accuracy of Adrenal Venous Sampling in Comparison with Other Parameters in Primary Aldosteronism

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