What is the role of adrenal imaging in the workup of hyperaldosteronism?

Updated: Oct 19, 2018
  • Author: George P Chrousos, MD, FAAP, MACP, MACE, FRCP(London); Chief Editor: Robert P Hoffman, MD  more...
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Answer

The sensitivity and specificity of adrenal imaging with 1.25-3 mm cuts for APA is 78% and 75%, respectively. Findings may range from normal-appearing or slightly enlarged adrenal glands suggestive of bilateral adrenal hyperplasia, to small, homogeneous, hypodense nodules characteristic of APAs or, rarely, large, dense heterogeneous masses suggestive of ACC (almost always >4 cm in diameter).

In one large series, the mean APA size was 1.8 cm; however, 19% of these tumors were smaller than 1 cm. Aldosteronomas are typically lipid-rich and commonly appear as homogeneous lesions with a low Hounsfield number consistent with this high lipid content. Reported data show that if imaging alone was used for localization, 14.6% of patients would have undergone inappropriate adrenalectomy, whereas 19.1% would have been inappropriately excluded from surgery. Furthermore, in 3.9% of patients, the wrong adrenal might have been removed.


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