Node-by-node diagnosis for multiple ipsilateral nodules by segmental adrenal venous sampling in primary aldosteronism

Area of Science:

• Endocrinology
• Surgical Pathology
• Interventional Radiology

Background:

• Primary aldosteronism (PA) can present with multiple adrenocortical nodules.
• Accurate localization of aldosterone overproduction is crucial for surgical planning.

Purpose of the Study:

• To evaluate the pathological diagnosis of multiple adrenocortical nodules.
• To assess the node-by-node diagnostic capability of segmental adrenal venous sampling (sAVS).

Main Methods:

• Retrospective study of 162 patients undergoing adrenalectomy after sAVS.
• Histopathological analysis, including CYP11B2 immunohistochemistry, of resected nodules.
• Correlation of sAVS findings with histopathological results.

Main Results:

• 11 patients (6.8%) had 2-3 nodules on the surgical side.
• sAVS correctly identified aldosterone production in all cases with localized elevation.
• The positive predictive value for the primary suspected aldosterone-producing adenoma (APA) was 100%, while secondary/tertiary suspected APAs had a lower but significant predictive value.

Conclusions:

• sAVS is effective in diagnosing aldosterone production from multiple ipsilateral adrenal nodules.
• The study confirms the utility of sAVS for precise localization in complex PA cases.