Predictive value of preoperative tests in discriminating bilateral adrenal hyperplasia from an aldosterone-producing adrenal adenoma

John L. Phillips, McClellan M. Walther, John C. Pezzullo, Walter Rayford, Peter L. Choyke, Arlene A. Berman, W. Marston Linehan, John L. Doppman, John R. Gill

Research output: Contribution to journalArticle

133 Citations (Scopus)

Abstract

In primary hyperaldosteronism, discriminating bilateral adrenal hyperplasia (BAH) from an aldosterone-producing adenoma (APA) is important because adrenalectomy, which is usually curative in APA, is seldom effective in BAH. We analyzed the results from our most recent 7-yr series to evaluate the predictive value of preoperative noninvasive tests compared with adrenal vein sampling (AVS). Forty-eight patients with hypertensive hyperaldosteronism underwent bedside testing, computed tomography (CT) imaging, and AVS. Those in whom the results of AVS indicated APA underwent adrenalectomy. Twelve (30%) and 14 (34%) of 41 patients with APA had paradoxical falls with ambulation in plasma aldosterone concentration (PAC) and 18-hydroxycorticosterone (18-OH-B), respectively. Twenty-nine (70%) and 26 (65%) APA patients had a rise in PAC and 18-OH-B, respectively, as did all 8 BAH patients. Significant identifiers of BAH were supine PAC values less than 15 ng/dL (P = 0.04), an increase greater than 60% (P = 0.02) in PAC with ambulation, and supine 18-OH-B values less than 60 ng/dL (P = 0.04). CT imaging alone was not predictive for BAH or APA. In our population, patients with a positive bedside test result (e.g. a fall in PAC and/or 18-OH-B) and a unilateral adrenal nodule on CT (10 of 41 patients) could have proceeded directly to adrenalectomy for APA. However, a positive bedside test result with a negative CT or a negative bedside test result regardless of CT findings required AVS to confirm the diagnosis and site of disease.

Original languageEnglish (US)
Pages (from-to)4526-4533
Number of pages8
JournalJournal of Clinical Endocrinology and Metabolism
Volume85
Issue number12
DOIs
StatePublished - Jan 1 2000
Externally publishedYes

Fingerprint

Predictive Value of Tests
Aldosterone
Adenoma
Hyperplasia
Tomography
Veins
Adrenalectomy
Plasmas
Sampling
Hyperaldosteronism
Walking
18-Hydroxycorticosterone
Imaging techniques

All Science Journal Classification (ASJC) codes

  • Endocrinology, Diabetes and Metabolism
  • Biochemistry
  • Endocrinology
  • Clinical Biochemistry
  • Biochemistry, medical

Cite this

Predictive value of preoperative tests in discriminating bilateral adrenal hyperplasia from an aldosterone-producing adrenal adenoma. / Phillips, John L.; Walther, McClellan M.; Pezzullo, John C.; Rayford, Walter; Choyke, Peter L.; Berman, Arlene A.; Linehan, W. Marston; Doppman, John L.; Gill, John R.

In: Journal of Clinical Endocrinology and Metabolism, Vol. 85, No. 12, 01.01.2000, p. 4526-4533.

Research output: Contribution to journalArticle

Phillips, John L. ; Walther, McClellan M. ; Pezzullo, John C. ; Rayford, Walter ; Choyke, Peter L. ; Berman, Arlene A. ; Linehan, W. Marston ; Doppman, John L. ; Gill, John R. / Predictive value of preoperative tests in discriminating bilateral adrenal hyperplasia from an aldosterone-producing adrenal adenoma. In: Journal of Clinical Endocrinology and Metabolism. 2000 ; Vol. 85, No. 12. pp. 4526-4533.
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AU - Phillips, John L.

AU - Walther, McClellan M.

AU - Pezzullo, John C.

AU - Rayford, Walter

AU - Choyke, Peter L.

AU - Berman, Arlene A.

AU - Linehan, W. Marston

AU - Doppman, John L.

AU - Gill, John R.

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AB - In primary hyperaldosteronism, discriminating bilateral adrenal hyperplasia (BAH) from an aldosterone-producing adenoma (APA) is important because adrenalectomy, which is usually curative in APA, is seldom effective in BAH. We analyzed the results from our most recent 7-yr series to evaluate the predictive value of preoperative noninvasive tests compared with adrenal vein sampling (AVS). Forty-eight patients with hypertensive hyperaldosteronism underwent bedside testing, computed tomography (CT) imaging, and AVS. Those in whom the results of AVS indicated APA underwent adrenalectomy. Twelve (30%) and 14 (34%) of 41 patients with APA had paradoxical falls with ambulation in plasma aldosterone concentration (PAC) and 18-hydroxycorticosterone (18-OH-B), respectively. Twenty-nine (70%) and 26 (65%) APA patients had a rise in PAC and 18-OH-B, respectively, as did all 8 BAH patients. Significant identifiers of BAH were supine PAC values less than 15 ng/dL (P = 0.04), an increase greater than 60% (P = 0.02) in PAC with ambulation, and supine 18-OH-B values less than 60 ng/dL (P = 0.04). CT imaging alone was not predictive for BAH or APA. In our population, patients with a positive bedside test result (e.g. a fall in PAC and/or 18-OH-B) and a unilateral adrenal nodule on CT (10 of 41 patients) could have proceeded directly to adrenalectomy for APA. However, a positive bedside test result with a negative CT or a negative bedside test result regardless of CT findings required AVS to confirm the diagnosis and site of disease.

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