Ces radiol. 2012, 66(2):139-147

State of the art in diagnosing primary hyperaldosteronismReview article

Filip Čtvrtlík¹, Martin Köcher¹, Marie Černá¹, Jan Václavík², Igor Hartmann³

¹ Radiologická klinika FN, Olomouc

² I. interní klinika FN, Olomouc

³ Urologická klinika FN, Olomouc

Primary hyperaldosteronism (PA) is one of the most frequent causes of secondary arterial hypertension. Distinguishing the two major causes of PA, i.e. adrenal adenoma from bilateral adrenal hyperplasia, is essential for further therapeutic strategy. Adrenal adenoma is indicated to adrenalectomy whereas bilateral hyperplasia is treated medically. Laboratory distinction between the forms of PA is not possible and the results of adrenal CT or MRI scans are often misleading. The gold standard for distinguishing both forms of PA is adrenal vein catheterization with sequential blood sampling to determine aldosterone and cortisol levels in order to address the question whether hormone overproduction is unilateral or bilateral. In their review article, the authors present the classification of individual forms of PA, its clinical presentation, laboratory diagnosis, and options of imaging techniques. The role of adrenal vein catheterization is described in detail. The performance technique and the criteria for appropriate selectivity of blood sampling to determine hormone levels are discussed. The article is concluded with a description of treatment options.

Keywords: adrenal adenoma, adrenal vein sampling, primary hyperaldosteronism, computed tomography

Accepted: May 1, 2012; Published: June 1, 2012  Show citation