Noninvasive adrenal imaging in hyperaldosteronism

Proper management of primary aldosteronism requires localization of excess aldosterone production. Partial or radical adrenalectomy may cure cases of aldosterone-producing adenomas; however, pharmacologic management is indicated in cases of bilateral adrenal hyperplasia. Differentiating among the causes of primary aldosteronism can be a diagnostic challenge. Adrenal vein sampling, the gold standard for diagnosing subtypes of primary aldosteronism, is an invasive and often difficult procedure. Advancements in CT and MRI have improved their adrenal-imaging capabilities, but accuracy in identifying aldosterone-producing adenomas remains inferior to adrenal vein sampling. Radionuclide scintigraphy has been used for many years and can also provide functional information for diagnosis. No diagnostic test, however, distinguishes with complete accuracy aldosterone-producing adenomas from bilateral adrenal hyperplasia in primary aldosteronism. Therefore, a combination of diagnostic techniques may most effectively guide medical management.