Predictive Value of Preoperative Tests in Discriminating Bilateral Adrenal Hyperplasia from an Aldosterone-Producing Adrenal Adenoma

Over the past 4 and 1/2 years, a total of 97 patients had hypertension yet lacked clinical, laboratory and radiological evidence of renal, renovascular and endocrine disease were investigated for A/R ratio. High A/R was detected in 30 patients. Five patients had unilateral adrenal adenoma and 1 had cancer while 24 patients (24.7%) had bilateral enlargements indicating bilateral adrenal hyperplasia (BAH). Our study has shown that BAH is: (a) easily diagnosed with a combination of A/R ratio and CT scan of the adrenal gland, (b) responsible for 24.7% of hypertension cases, (c) associated with moderate to severe hypertension that may require 2-4 antihypertensives, (d) associated with hypokalemia in only in 54% of the cases, (e) not controlled with a single daily dose of Spironolactone (S) and ½ the cases require 50 mg/day. Moreover, it has shown that S treatment was not associated with significant hyperkalemia yet gynecomastia and erectile dysfunction were common side effects. Interestingly; and despite normalization of A/R ratio, most patients continue to require antihypertensive drugs though the number and dosage were less. The latter phenomenon was more evident in those with higher initial A/R ratio and longer duration of hypertension. Nephroangiosclerosis is the most plausible explanation for it. In conclusion; BAH is not a rare disease and should be considered in cases of refractory hypertension. Keywords: Aldosterone, Aldosterone/Renin ratio, hypertension, Spironolactone.

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Abstract #806988: Unilateral Adrenal Adenoma with Bilateral Adrenal Hyperplasia

Endocrine Practice ◽

10.1016/s1530-891x(20)39773-1 ◽

2020 ◽

Vol 26 ◽

pp. 31-32

Author(s):

Arpita Bhalodkar

Keyword(s):

Adrenal Adenoma ◽

Adrenal Hyperplasia ◽

Bilateral Adrenal Hyperplasia

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A Case of Primary Aldosteronism due to Bilateral Adrenal Hyperplasia with Hidden Undiagnosed Adrenal Adenoma for Eight Years

Ewha Medical Journal ◽

10.12771/emj.1996.19.1.47 ◽

1996 ◽

Vol 19 (1) ◽

pp. 47

Author(s):

Seock Ah Im ◽

Eun Mi Nam ◽

Si Hoon Park ◽

Gil Ja Shin ◽

Woo Hyung Lee ◽

...

Keyword(s):

Primary Aldosteronism ◽

Adrenal Adenoma ◽

Adrenal Hyperplasia ◽

Bilateral Adrenal Hyperplasia

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Iatrogenic myxoedema madness following radioactive iodine ablation for Graves' disease, with a concurrent diagnosis of primary hyperaldosteronism

Endocrinology Diabetes and Metabolism Case Reports ◽

10.1530/edm-15-0087 ◽

2015 ◽

Vol 2015 ◽

Cited By ~ 3

Author(s):

V Larouche ◽

L Snell ◽

D V Morris

Keyword(s):

Radioactive Iodine ◽

Psychiatric Symptoms ◽

Adrenal Adenoma ◽

Primary Hyperaldosteronism ◽

Graves Disease ◽

List Type ◽

Adrenal Hyperplasia ◽

Bilateral Adrenal Hyperplasia ◽

Acute Hypothyroidism ◽

Radioactive Iodine Ablation

Summary Myxoedema madness was first described as a consequence of severe hypothyroidism in 1949. Most cases were secondary to long-standing untreated primary hypothyroidism. We present the first reported case of iatrogenic myxoedema madness following radioactive iodine ablation for Graves' disease, with a second concurrent diagnosis of primary hyperaldosteronism. A 29-year-old woman presented with severe hypothyroidism, a 1-week history of psychotic behaviour and paranoid delusions 3 months after treatment with radioactive iodine ablation for Graves' disease. Her psychiatric symptoms abated with levothyroxine replacement. She was concurrently found to be hypertensive and hypokalemic. Primary hyperaldosteronism from bilateral adrenal hyperplasia was diagnosed. This case report serves as a reminder that myxoedema madness can be a complication of acute hypothyroidism following radioactive iodine ablation of Graves' disease and that primary hyperaldosteronism may be associated with autoimmune hyperthyroidism. Learning points Psychosis (myxoedema madness) can present as a neuropsychiatric manifestation of acute hypothyroidism following radioactive iodine ablation of Graves' disease. Primary hyperaldosteronism may be caused by idiopathic bilateral adrenal hyperplasia even in the presence of an adrenal adenoma seen on imaging. Adrenal vein sampling is a useful tool for differentiating between a unilateral aldosterone-producing adenoma, which is managed surgically, and an idiopathic bilateral adrenal hyperplasia, which is managed medically. The management of autoimmune hyperthyroidism, iatrogenic hypothyroidism and primary hyperaldosteronism from bilateral idiopathic adrenal hyperplasia in patients planning pregnancy includes delaying pregnancy 6 months following radioactive iodine treatment and until patient is euthyroid for 3 months, using amiloride as opposed to spironolactone, controlling blood pressure with agents safe in pregnancy such as nifedipine and avoiding β blockers. Autoimmune hyperthyroidism and primary hyperaldosteronism rarely coexist; any underlying mechanism associating the two is still unclear.

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Diagnostic Efficacy of CT/MR Imaging and Adrenal Vein Sampling for Localization of Aldosterone-producing Adrenal Adenomas in Primary Aldosteronism

The ASEAN Journal of Radiology ◽

10.46475/aseanjr.v19i2.26 ◽

2019 ◽

Vol 19 (2) ◽

pp. 88-99

Author(s):

Nontika Boontankan ◽

Kewalee Sasiwimonphan

Keyword(s):

Mr Imaging ◽

Predictive Value ◽

Adrenal Adenoma ◽

Adrenal Vein ◽

Adrenal Hyperplasia ◽

Adrenal Vein Sampling ◽

Diagnostic Efficacy ◽

Sensitivity Specificity ◽

Bilateral Lesions ◽

Adrenal Nodule

Objective: To test the sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) of CT/MR imaging and adrenal vein sampling (AVS) for diagnosis of aldosterone-producing adrenal adenoma (APA). Material and method: Retrospective study of 14 patients with primary hyperaldosteronism (PAL) who underwent both CT/MR imaging and AVS between June 2007 and June 2012 were performed. The study included 7 male and 7 female patients. Review CT/MR findings of these cases and compared with AVS results were done. Results: Five of fourteen patients (35%) had unilateral adrenal nodules on CT, and one of fourteen patients (7.1%) had bilateral adrenal nodules on CT[D1]. The remaining eight patients had no significant nodules in both adrenal glands. Among 5 patients who had unilateral adrenal nodule detected from CT, 4 patients (80%) with nodule greater than 10 mm also presented with lateralization from AVS and finally pathological proven APA. The last patient with unilateral nodule showed small size less than 10 mm and had AVS results of bilateral lesion. Medical therapy was applied for this patient instead of surgical treatment. In other group (8 of 14 patients, 57.1%), there was no significant nodule from CT or MRI and AVS results indicated bilateral lesions in two patients (25%). The rest of six patients found unilateral lesion on AVS which underwent adrenalectomy and histological revealed adrenal hyperplasia of all cases. Two of six patients concluded to be primary adrenal hyperplasia (PAH) or unilateral adrenal hyperplasia (UAH), which showed clinical cure after adenalectomy. The remaining four patients who showed no improvement of hypertension after adrenalectomy concluded to be bilateral adrenal hyperplasia (BAH). The sensitivity, specificity, accuracy, PPV and NPV for detected adrenal adenoma by CT/MRI of our study were 66.67%, 87.50%, 78.57%, 80.00%, and 77.78%, respectively. The sensitivity, specificity, accuracy, PPV and NPV for detected adrenal adenoma by AVS at cut point AVS ratio at 2 were 100%, 50%, 71.43%, 60% and 100%, respectively. Conclusion: In patient with suspected PAL who presented with unilateral adrenal nodule at least 10 mm in size detected by CT, these patient should be referred for adrenalectomy without need to performing AVS. The differentiation of subtype in patients with PAL is most reliably achieved with AVS which may reserve for patient who had no significant adrenal nodule from CT/MRI.

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Macronodular bilateral adrenal hyperplasia: diagnose the aberrant receptors and current aspects of treatment

Consilium Medicum ◽

10.26442/2075-1753_2016.10.29-33 ◽

2016 ◽

Vol 18 (10) ◽

pp. 29-33

Author(s):

M.Yu. Yukina ◽

◽

N.F. Nuralieva ◽

D.G. Beltsevich ◽

E.A. Troshina ◽

...

Keyword(s):

Adrenal Hyperplasia ◽

Bilateral Adrenal Hyperplasia

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18F-FDG uptake in bilateral adrenal hyperplasia causing Cushing?s syndrome

European Journal of Nuclear Medicine and Molecular Imaging ◽

10.1007/s00259-004-1629-3 ◽

2004 ◽

Vol 32 (3) ◽

pp. 384-384 ◽

Cited By ~ 11

Author(s):

Sandip Basu ◽

Narendra Nair

Keyword(s):

Adrenal Hyperplasia ◽

Fdg Uptake ◽

Bilateral Adrenal Hyperplasia ◽

18F Fdg

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High Reliability of Neonatal Screening for Congenital Adrenal Hyperplasia in Switzerland

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/jc.2002-012093 ◽

2002 ◽

Vol 87 (9) ◽

pp. 4106-4110 ◽

Cited By ~ 29

Author(s):

Michael Steigert ◽

Eugen J. Schoenle ◽

Anna Biason-Lauber ◽

Toni Torresani

Keyword(s):

Positive Predictive Value ◽

Congenital Adrenal Hyperplasia ◽

Predictive Value ◽

Neonatal Screening ◽

Screening Program ◽

High Reliability ◽

Dried Blood Spots ◽

Recall Rate ◽

Adrenal Hyperplasia ◽

Salt Wasting

Newborn screening for congenital adrenal hyperplasia (CAH) is justified by the sometimes difficult clinical diagnosis and the risks associated with missed diagnosis, particularly the life-threatening salt-wasting crisis. In Switzerland, nationwide screening for CAH by measuring 17-hydroxyprogesterone levels in dried blood spots was introduced in 1992. At the Zurich University Children’s Hospital, 50% of the population of Switzerland is screened. The aim of the study was to evaluate the efficiency of the Zurich screening program. Between January 1, 1993, and May 31, 2001, 333,221 newborns were screened for CAH. Thirty-one newborns had CAH (incidence, 1 in 10,749); 30 were detected through screening (sensitivity, 97%). A recall for suspected CAH was performed in only 60 cases, corresponding to a very low recall rate (0.0018%). In 30 recalls CAH was confirmed (positive predictive value, 50%; specificity, 99.99%). Fifteen of 31 patients profited from screening, as CAH had not been recognized clinically. The timely availability of screening results made therapy possible within the first week of life in most cases and helped in preventing salt-wasting crisis in all patients. With a sensitivity of 97%, a specificity of 99.99%, and a positive predictive value of 50%, the Zurich neonatal screening program for CAH can be considered highly reliable.

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