June 22, 2016
In patients with primary aldosteronism, both adrenal CT scans and more-invasive adrenal vein sampling identified the presence of aldosterone-producing adenomas at similar rates and resulted in similar clinical benefits after 1 year of follow-up, but patients in both groups experienced unexpected surgical failures.
In a diagnostic, randomized controlled trial conducted at 13 Dutch and Polish medical centers, Tanja Dekkers, MD, of the division of vascular medicine at Radboud University Medical Center in Nijmegen, the Netherlands, and colleagues analyzed data from 184 adults with confirmed primary aldosteronism prescribed at least three antihypertensive drugs or with hypertension accompanied by spontaneous or diuretic-induced hypokalemia. Patients were recruited between July 2010 and May 2013. Researchers randomly assigned patients to undergo adrenal CT (n = 92) or adrenal vein sampling (AVS; n = 92). Patients assigned to CT underwent adrenalectomy in cases of a unilaterally enlarged adrenal with a normal contralateral gland; patients with bilaterally enlarged or normal adrenal glands were prescribed mineralocorticoid receptor antagonist therapy. Antihypertensive therapy was initiated and adjusted by treating physicians during follow-up to achieve target blood pressure. Primary outcome was the intensity of antihypertensive medication needed; secondary endpoints included serum potassium level and aldosterone after salt-loading test following adrenalectomy.