Management of Primary Aldosteronism: Should Adrenal Gland Computed Tomography be Replaced by Adrenal Venous Sampling?

Full Article

CH Lam, HL Chow, SH Chiu, HY Cho, S Lau, CY Lui

Hong Kong J Radiol 2014;17:23-9

DOI: 10.12809/hkjr1413184

Objectives: To evaluate the accuracy of computed tomography (CT) in the management of primary aldosteronism by comparing the concordance between CT and adrenal venous sampling (AVS), and the feasibility of AVS as a standard component in the diagnostic workup.

Methods: From January 2009 to December 2012, 44 instances of AVS performed in 39 patients in Kwong Wah Hospital, Hong Kong were reviewed. All these patients had undergone CT of the adrenal glands before AVS. CT findings, and aldosterone and cortisol profiles of the left adrenal vein, right adrenal vein, and inferior vena cava during AVS were compared. Successful cannulation was defined by achieving an adrenal vein to the inferior vena cava cortisol level ratio of higher than 1.1. The positive predictive value of CT and concordance between CT and AVS were calculated. The pathology reports of patients who underwent adrenalectomy were reviewed.

Result: AVS was successful in 35 (90%) of the patients on the first attempt, and concordance between CT and AVS was observed in 23 (59%) patients. CT yielded a positive predictive value of 73% and 44% in unilateral disease and bilateral disease, respectively. A total of 27 patients with unilateral disease underwent adrenalectomy. Pathology confirmed cortical adenoma in all specimens.

Conclusion: CT is not an accurate tool for the management of primary aldosteronism, especially in bilateral disease. AVS as a standard procedure in the workup is feasible but depends on proper technique and radiologists with adequate experience.