Primary aldosteronism subtype discordance between computed tomography and adrenal venous sampling

Area of Science:

• Endocrinology
• Surgical Oncology
• Radiology

Background:

• Primary aldosteronism (PA) diagnosis typically involves CT and adrenal venous sampling (AVS).
• Discordance between CT and AVS findings is common, particularly in patients with bilateral adrenal lesions on CT.
• The benefit of unilateral adrenalectomy in PA patients with CT-AVS discordance remains unclear.

Purpose of the Study:

• To evaluate the surgical outcomes of unilateral adrenalectomy in patients with PA and discordant CT-AVS findings.
• To determine if patients with bilateral lesions on CT but unilateral disease on AVS benefit from surgery.

Main Methods:

• Retrospective analysis of 362 PA patients who underwent both CT and AVS.
• Surgical outcomes assessed using Primary Aldosteronism Surgical Outcome criteria.
• Comparison of outcomes between patients with bilateral CT lesions/unilateral AVS disease and unilateral CT lesions/ipsilateral AVS disease.

Main Results:

• The AVS success rate was 89% in patients with bilateral CT lesions.
• A 39% discordance rate between CT and AVS was observed in patients with bilateral CT lesions.
• While complete biochemical success was lower (41% vs. 80%), combined clinical and biochemical benefits were not significantly different between discordant and concordant unilateral cases (76% vs. 93% and 70% vs. 90%).

Conclusions:

• Patients with primary aldosteronism and bilateral lesions on CT but unilateral disease on AVS benefit from unilateral adrenalectomy.
• Adrenal venous sampling (AVS) is recommended for surgical candidates with CT findings suggestive of bilateral adrenal lesions.
• This study supports surgical intervention for selected PA patients despite CT-AVS discordance.