Adrenal vein sampling in differential diagnosis of primary aldosteronism on the example of a clinical case

Primary aldosteronism is the most common cause of endocrine hypertension, occurring in 5–10% of patients with hypertension. Convincing evidence has been obtained indicating that primary aldosteronism increases the risk of cardiovascular complications, respectively, early diagnosis and treatment of patients with the definition of further tactics is a key step to prevent the progression of cardiovascular complications. The choice of the most appropriate treatment method for patients with primary aldosteronism depends on the diagnosis of nosological subtypes – bilateral adrenal hyperplasia (also known as idiopathic aldosteronism), which recommends a conservative treatment or unilateral aldosteronism due to aldosterone-producing adenoma, in which surgical treatment (adrenalectomy) is the tactic of choice. In addition, the "obvious" adrenal adenomas may in fact turn out to be areas of focal hyperplasia – a diagnostic error in this case leads to the unreasonable implementation of adrenalectomy. In order to clarify the lateralization of aldosterone hyperproduction, adrenal venous sampling is used. However, this method requires constant radiography, qualified endovascular surgery and is carried out in centralized medical hospitals. In this clinical case, we want to demonstrate the importance of a diagnosis of primary aldosteronism step by step

Russian Association of Endocrinologists clinical practice guideline for adrenal incidentalomas differential diagnosis

This article discusses the management guidelines for serendipitously diagnosed adrenal masses cases, assessment of their hormonal activity and malignancy potential, pro- and contra indications for surgical treatment and follow-up algorithm for hormonally inactive tumors. Hypercathecholaminemya, endogenous hypercortisolism, primary hyperaldosteronism should be considered as variants of specific hormonal activity of tumor. The midnight suppression test with dexametasone 1 mg is recommended in all cases. Evaluation of basal ACTH in case of negative result of the test with dexametasone 1 mg (absence of morning cortisol level suppression) should be considered as confirmation test. For primary diagnosis of pheohromocytoma/paraganglioma (PPGL) a free plasma or fractionated urine methanephrines concentrations evaluation should be recommended. If test is positive, comprehensive examination to exclude or confirm PPGL is necessity. The aldosterone/rennin ratio exposure should be considered for patients with arterial hypertension to exclude primary hyperaldosteronism. To evaluate malignant pattern of a tumor in all unclear cases should be provide assessment of computed tomography quantitative indices. Adrenal incidentalomas treatment guidelines isnt considered in the field of this recommendations and reported in relevant guidelines