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From the Clinical Research Centers |
Urologic Oncology Branch/National Cancer Institute (J.L.P., M.M.W., W.R., A.A.B., W.M.L.), Hypertension-Endocrine Branch/National Heart, Lung and Blood Institute (J.R.G.), and Department of Radiology/Walter Magnusson Clinical Center/National Institutes of Health (P.L.C., J.L.D.), Bethesda, Maryland 20892-1501; and Department of Pharmacology (J.C.P.), Georgetown University, Washington, DC
Address correspondence and requests for reprints to: John L. Phillips, M.D., Urologic Cancer Institute, National Cancer Institute, Building 10, Room 2B47, Bethesda, Maryland 20892-1501.
In primary hyperaldosteronism, discriminating bilateral adrenal hyperplasia (BAH) from an aldosterone-producing adenoma (APA) is important because adrenalectomy, which is usually curative in APA, is seldom effective in BAH. We analyzed the results from our most recent 7-yr series to evaluate the predictive value of preoperative noninvasive tests compared with adrenal vein sampling (AVS). Forty-eight patients with hypertensive hyperaldosteronism underwent bedside testing, computed tomography (CT) imaging, and AVS. Those in whom the results of AVS indicated APA underwent adrenalectomy. Twelve (30%) and 14 (34%) of 41 patients with APA had paradoxical falls with ambulation in plasma aldosterone concentration (PAC) and 18-hydroxycorticosterone (18-OH-B), respectively. Twenty-nine (70%) and 26 (65%) APA patients had a rise in PAC and 18-OH-B, respectively, as did all 8 BAH patients. Significant identifiers of BAH were supine PAC values less than 15 ng/dL (P = 0.04), an increase greater than 60% (P = 0.02) in PAC with ambulation, and supine 18-OH-B values less than 60 ng/dL (P = 0.04). CT imaging alone was not predictive for BAH or APA. In our population, patients with a positive bedside test result (e.g. a fall in PAC and/or 18-OH-B) and a unilateral adrenal nodule on CT (10 of 41 patients) could have proceeded directly to adrenalectomy for APA. However, a positive bedside test result with a negative CT or a negative bedside test result regardless of CT findings required AVS to confirm the diagnosis and site of disease.
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