Laboratory Diagnostics of Primary Hyperaldosteronism and its Peculiarities (Literature Review)

Abstract

The final stage of the diagnostic of primary hyperaldosteronism is to identify the causes of excessive secretion of aldosterone and determination of its variants. Based on the analysis of literature data, the diagnostic value, sensitivity and specificity of the methods of radiation diagnostics for primary hyperaldosteronism were assessed: ultrasound, computed tomography, magnetic resonance imaging, photon emission tomography, magnetic resonance spectroscopy, scintigraphy with iodine radiopharmaceuticals. The causes of false-positive and false-negative evaluations of changes in adrenal glands in the application of these diagnostics have been analyzed. There are many genetic and morphological studies when searching the literature data on the principles and methods of distinguishing the nosological forms of primary hyperaldosteronism based on the results of the aldosterone level estimation in the separated blood from the central veins of both adrenal glands or segmental veins of one gland with subsequent determination of the concentration gradient. It was noted that topical diagnostics and, especially, the determination of nosological forms of primary hyperaldosteronism are complex and expensive, but their results allow choosing an appropriate treatment approach for each particular case.

The Management of Primary Hyperaldosteronism in a Poor Technology Environment

“…Nevertheless, in patients less than 35 years old with evident hypokalemia and unilateral adrenal adenoma greater than 10 mm diameter, adrenal vein sampling is not mandatory [ 29 , 30 ]: the clinician can rely on the aldosterone to renin ratio coupled with imaging. Best imaging for adrenals are computed tomography (sensitivity = 84.3%) and magnetic resonance imaging (sensitivity = 97%, specificity = 90%) [ 29 ]. Sometimes imaging can be normal, and reimaging months later may detect an adrenal adenoma [ 31 ].…”

Progress on Genetic Basis of Primary Aldosteronism

“…FA type I should be suspected in patients with: PA diagnosed at a young age (before the age of 30); A positive family history of PA; Family members with a history of cerebrovascular accidents at an early age [ 13 ]. …”

“…In addition to the tests typically used to detect PA, laboratory diagnostics include the dexamethasone suppression test [ 13 ]. With dexamethasone suppression testing, dexamethasone can be prescribed at a dose of 1 mg twice daily for three days.…”

“…After the diagnosis of PA is made, diagnostic imaging should be performed in order to determine the cause of the autonomic secretion of aldosterone. In patients with PA, a radiographic evaluation of the adrenal glands by computed tomography (CT) or magnetic resonance (MR) of the abdominal cavity is necessary [ 13 ]. In doubtful cases, adrenal scintigraphy is performed in specialized centers (the gold standard in the differentiation of PA forms).…”