THE PREOPERATIVE DIAGNOSIS OF PRIMARY ALDOSTERONISM BY THIN-SECTION COMPUTED TOMOGRAPHY
Abstract
Primary aldosteronism or Conn's syndrome is characterized by hypertension and hypokalemia resulting from elevated aldosterone. Up to 80% of cases are due to adrenocortical adenoma and the remaining 20% of cases are due to bilateral adrenal hyperplasia. Fewer than 1% of cases are due to carcinoma. The radiologic distinction between adenoma and hyperplasia is important because the treatment for adenoma is adrenalectomy, whereas medical therapy is indicated in hyperplasia. Several techniques have been used to make this distinction including: adrenal venous sampling, adrenal venography, scintigraphy, CT and MR imaging. Adrenal venous sampling and venography are invasive procedures even when done by the most experienced angiographer. Scintigraphy and MR imaging are not widely available. Many studies have advocated computed tomography in the investigation of patients with primary aldosteronism. We present 5 cases of primary aldosteronism due to functioning adrenocortical adenomas correctly diagnosed by thin- slice CT. All adenomas were less than 2 cm. with homogeneous low density.
We propose that CT should be the investigation of choice for patients with clinically suspected primary aldosteronism.
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