Identification of Surgically Curable Primary Aldosteronism by Imaging in a Large, Multiethnic International Study


This international multicenter study took place in tertiary referral centers. A total of 1625 PA patients seeking surgical cure were enrolled in an international study involving 19 centers in North America, Europe, Asia, and Australia. Of these, 1311 (81%) had imaging data available and 369 (23%), who received a final diagnosis of surgically cured unilateral PA, were examined. Patients underwent AVS and imaging by computed tomography and/or magnetic resonance imaging. The accuracy of detection of unilateral PA at imaging was estimated by the area under the receiver operator characteristics curve using cure (biochemical and/or full clinical success) as the reference at follow-up after unilateral adrenalectomy. In the cohort of 1311 patients with imaging data available, 34% and 7% of cases showed no detectable or bilateral nodules, respectively. Imaging did not detect the culprit adrenal in 28% of the surgically cured unilateral PA patients. Moreover, the clinical outcome did not differ significantly between the imaging-positive and imaging-negative patients. Cross-sectional imaging did not identify a lateralized cause of disease in around 40% of PA patients and failed to identify the culprit adrenal in more than one-fourth of patients with unilateral PA.

Authors: Gian Paolo Rossi, Filippo Crimì, Giacomo Rossitto, Laurence Amar, Michel Azizi, Anna Riester, Martin Reincke, Christoph Degenhart, Jiri Widimsky, Mitsuhide Naruse, Jaap Deinum, Leo Schultze Kool, Tomaz Kocjan, Aurelio Negro, Ermanno Rossi, Gregory Kline, Akiyo Tanabe, Fumitoshi Satoh, Lars Christian Rump, Oliver Vonend, Holger S Willenberg, Peter J Fuller, Jun Yang, Nicholas Yong Nian Chee, Steven B Magill, Zulfiya Shafigullina, Marcus Quinkler, Anna Oliveras, Vin Cent Wu, Zuzana Kratka, Giulio Barbiero, Teresa Maria Seccia, Michele Battistel
Keywords: CT, MRI, imaging, diagnosis
DOI Number: 10.1210/clinem/dgab482      Publication Year: 2021

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