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Role of Radiology in the Management of Primary Aldosteronism¹

¹ From the Departments of Radiology (S.M.P., R.K.L., T.I.B., T.L.T.) and Endocrinology (B.B.), Central Middlesex and Northwick Park Hospitals, North West London Hospitals (NWLH) Trust, Watford Rd, Harrow HA1 3UJ, England. Presented as an education exhibit at the 2005 RSNA Annual Meeting. Received August 11, 2006; revision requested September 11 and received November 27; accepted December 4. All authors have no financial relationships to disclose. Address correspondence to R.K.L. (e-mail: raviklingam{at}yahoo.co.uk).

The diagnosis of primary aldosteronism, the most common form of secondary hypertension,

is based on clinical and biochemical features. Although radiology plays no role in the initial diagnosis, it has an important role in differentiating between the two main causes of primary aldosteronism: aldosterone-producing adenoma (APA) and bilateral adrenal hyperplasia (BAH). This distinction is important because APAs are generally managed surgically and BAH medically. Adrenal venous sampling is considered the standard of reference for determining the cause of primary aldosteronism

but is technically demanding, operator dependent, costly, and time consuming, with a low but significant complication rate. Other imaging modalities, including computed tomography, magnetic resonance imaging, and adrenal scintigraphy, have also been used to determine the cause of primary aldosteronism. Cross-sectional imaging has traditionally focused on establishing the diagnosis of an APA, with that of BAH being one of exclusion. A high specificity for detecting an APA is desirable, since it will avert unnecessary surgery in patients with BAH. However, an overreliance on cross-sectional imaging can lead to the incorrect treatment of affected patients, mainly due to the wide variation in the reported diagnostic performance of these modalities. A combination of modalities is usually required to confidently determine the cause of primary aldosteronism. The quest for optimal radiologic management of primary aldosteronism continues just over a half century since this disease entity was first described.

© RSNA, 2007

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