Hyperaldosteronism (primary suspected)

Population Covered By The Guidance

This pathway provides guidance on the imaging of adult patients with biochemically confirmed primary hyperaldosteronism.

Lead Researcher: Arjun Shivananda

Experts & Contributors: Ravinder Dhillon, David Hurley, Anita Kothapalli, Kyaw Thura

Editorial Panel: Editorial Panel
Link to Editorial Panel

Date reviewed: October 2017

Date Published: February 2018

Image 1a, b and c (Computed Tomography): There is a 12mm sized rounded hypodense mass lesion noted in the right adrenal gland. There is marked contrast wash-out demonstrated in the lesion which is in keeping with adenoma.

Adrenal Adenoma

Image 1a, b and c (Computed Tomography): There is a 12mm sized rounded hypodense mass lesion noted in the right adrenal gland. There is marked contrast wash-out demonstrated in the lesion which is in keeping with adenoma.

Adrenal Adenoma

Image 1a, b and c (Computed Tomography): There is a 12mm sized rounded hypodense mass lesion noted in the right adrenal gland. There is marked contrast wash-out demonstrated in the lesion which is in keeping with adenoma.

Adrenal Adenoma

Image 1d (Adrenal Vein Sampling): A sample is taken from the left adrenal vein for analysis and comparison to that from the right renal vein.

Adrenal Adenoma

Image 2a: Adrenalectomy specimen showing a typical adrenocortical adenoma forming a circumscribed and encapsulated mass with a homogenous yellow cut surface. Note the residual adrenal parenchyma at the periphery of the lesion (arrow).

Adrenocortical Adenoma

Image 2b (H&E, x2.5) and 2c (H&E, x10): Histological section showing the pushing border between the adenoma and the surrounding parenchyma (arrows) At higher power, the cells form sheets and nests and exhibit uniform nuclei and clear cytoplasm due to their high lipid content.

Adrenocortical Adenoma

Image 2b (H&E, x2.5) and 2c (H&E, x10): Histological section showing the pushing border between the adenoma and the surrounding parenchyma (arrows) At higher power, the cells form sheets and nests and exhibit uniform nuclei and clear cytoplasm due to their high lipid content.

Adrenocortical Adenoma

 

Date of literature search: September 2017

References are graded from Level I to V according to the Oxford Centre for Evidence-Based Medicine, Levels of Evidence. Download the document

  1. Thakkar RB, Oparil S. Primary aldosteronism: a practical approach to diagnosis and treatment. J Clin Hypertens (Greenwich). 2001;3(3):189-95. (Review article). View the reference
  2. Buffolo F, Monticone S, Williams TA, Rossato D, Burrello J, Tetti M, et al. Subtype Diagnosis of Primary Aldosteronism: Is Adrenal Vein Sampling Always Necessary? International Journal of Molecular Sciences. 2017;18(4):848. (Review article). View the reference
  3. Gordon RD, Stowasser M, Tunny TJ, Klemm SA, Rutherford JC. High incidence of primary aldosteronism in 199 patients referred with hypertension. Clin Exp Pharmacol Physiol. 1994;21(4):315-8. (Level II evidence). View the reference
  4. Ganguly A. Primary aldosteronism. N Engl J Med. 1998;339(25):1828-34. (Review article). View the reference
  5. Stowasser M, Gordon RD. Primary Aldosteronism: Changing Definitions and New Concepts of Physiology and Pathophysiology Both Inside and Outside the Kidney. Physiol Rev. 2016;96(4):1327-84. (Review article). View the reference
  6. Iacobone M, Citton M, Viel G, Rossi GP, Nitti D. Approach to the surgical management of primary aldosteronism. Gland Surg. 2015;4(1):69-81. (Review article). View the reference
  7. Bornstein SR, Stratakis CA, Chrousos GP. Adrenocortical tumors: recent advances in basic concepts and clinical management. Ann Intern Med. 1999;130(9):759-71. (Review article). View the reference
  8. Schirpenbach C, Reincke M. Screening for primary aldosteronism. Best Pract Res Clin Endocrinol Metab. 2006;20(3):369-84. (Review article). View the reference
  9. Doppman JL, Gill JR, Jr., Miller DL, Chang R, Gupta R, Friedman TC, et al. Distinction between hyperaldosteronism due to bilateral hyperplasia and unilateral aldosteronoma: reliability of CT. Radiology. 1992;184(3):677-82. (Level II evidence). View the reference
  10. Harper R, Ferrett CG, McKnight JA, McIlrath EM, Russell CF, Sheridan B, et al. Accuracy of CT scanning and adrenal vein sampling in the pre-operative localization of aldosterone-secreting adrenal adenomas QJM: An International Journal of Medicine. 1999;92(11):643-50. (Level III evidence) View the reference
  11. Dunnick NR, Leight GS, Jr., Roubidoux MA, Leder RA, Paulson E, Kurylo L. CT in the diagnosis of primary aldosteronism: sensitivity in 29 patients. AJR Am J Roentgenol. 1993;160(2):321-4. (Level III evidence). View the reference
  12. Sohaib SA, Peppercorn PD, Allan C, Monson JP, Grossman AB, Besser GM, et al. Primary hyperaldosteronism (Conn syndrome): MR imaging findings. Radiology. 2000;214(2):527-31. (Level IV evidence). View the reference
  13. Kempers MJ, Lenders JW, van Outheusden L, van der Wilt GJ, Schultze Kool LJ, Hermus AR, et al. Systematic review: diagnostic procedures to differentiate unilateral from bilateral adrenal abnormality in primary aldosteronism. Ann Intern Med. 2009;151(5):329-37. (Review article). View the reference
  14. Magill SB, Raff H, Shaker JL, Brickner RC, Knechtges TE, Kehoe ME, et al Comparison of adrenal vein sampling and computed tomography in the differentiation of primary aldosteronism. J Clin Endocrinol Metab. 2001;86(3):1066-71. (Level III evidence). View the reference
  15. Mayo-Smith WW, Boland GW, Noto RB, Lee MJ. State-of-the-art adrenal imaging. Radiographics. 2001;21(4):995-1012. (Review article). View the reference

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Endocrine