Unilateral Disease Is Common in Patients With Primary Aldosteronism Without Adrenal Nodules

• Published in: Canadian journal of cardiology 2021-02, Vol.37 (2), p.269-275
• Main Authors: Sam, Davis, Kline, Gregory A., So, Benny, Przybojewski, Stefan J., Leung, Alexander A.
• Format: Article
• Language: English
• ISSN: 0828-282X; 1916-7075
• DOI: 10.1016/j.cjca.2020.05.013

Patients with primary aldosteronism (PA) without apparent adrenal nodularity have not been well characterised in the literature. The aim of this study was to assess for unilateral aldosterone hypersecretion among patients with primary aldosteronism with normal-appearing adrenals using adrenal vein sampling (AVS). In this cross-sectional study performed at a Canadian tertiary care centre, we reviewed all consecutive PA patients lacking a definitive adrenal nodule who were referred for AVS in the work-up of PA between January 2006 and May 2018. AVS indications included an elevated aldosterone-to-renin ratio and high-probability features of PA. In total, 174 patients were included (mean age, 52.0 years; 62.6% male), and 70 (40.2%) had unilateral aldosterone hypersecretion. There was a positive linear association between higher age categories (by decade) and lateralisation (P = 0.03). For every decade of age, there was a 30% higher odds of lateralisation (odds ratio, 1.03 per year; 95% confidence interval, 1.00-1.05). The frequency of lateralisation was higher in males compared with females (47.7% vs 27.7%), with a 2-fold greater odds of unilateral disease (odds ratio, 2.38; 95% confidence interval, 1.23-4.61). Traditional biomarkers of lateralisation among patients with adrenal nodules (eg, serum potassium and aldosterone-to-renin ratio levels) were not predictive of lateralisation in this population. Many patients with PA who lack definitive adrenal nodules have lateralising disease. Efforts to optimise referrals for AVS may be prioritised by focusing on patients most likely to have unilateral disease, especially males and older adults. Les patients atteints d’aldostéronisme primaire (AP) en l’absence de nodularité surrénalienne apparente ne sont pas bien décrits dans la littérature médicale. Nous avons tenté d'évaluer l’hypersécrétion unilatérale d’aldostérone chez les patients atteints d’AP présentant des glandes surrénaliennes en apparence normales à l’aide des résultats d’un cathétérisme veineux surrénalien (CVS). Dans le cadre de cette étude transversale réalisée dans un centre de soins tertiaires canadien, nous avons examiné le cas de tous les patients consécutifs atteints d’AP ne présentant pas de nodules surrénaliens apparents qui ont été dirigés pour subir un CVS aux fins d’investigation diagnostique d’AP entre janvier 2006 et mai 2018. Les indications pour la réalisation d’un CVS comprenaient un rapport aldostérone/rénine élevé et des caractéristiq