Pathways and dead ends in the diagnostics of primary aldosteronism

  • Sara Kukman Faculty of medicine, University of Ljubljana, Ljubljana, Slovenia
  • Tina Šmid Faculty of medicine, University of Ljubljana, Ljubljana, Slovenia
  • Tomaž Kocjan Department of Endocrinology, Diabetes and Metabolic Diseases, Division of Internal Medicine, University Medical Centre Ljubljana, Ljubljana, Slovenia
Keywords: adrenocortical adenoma, primary hyperaldosteronism, hypertension, adrenal vein sampling, adrenalectomy


We present a patient with a tumour of the left adrenal gland who has been treated for resistant hypertension and hypokalaemia for years. Primary aldosteronism was confirmed but despite multiple attempts of adrenal vein sampling we were unable to prove unilateral disease. Treatment with mineralocorticoid receptor antagonists was not successful, however no clear indication for operative treatment was present. Patient's clinical and laboratory characteristics pointed to unilateral disease, so he was referred for PET CT with 11-C-metomidate in the United Kingdom. Unilateral disease was confirmed, and the patient was cured with left-sided laparoscopic adrenalectomy.


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Accetto R, Salobir B, Brguljan Hitij J, Dolenc P. Slovenske smernice za obravnavo hipertenzije 2013. Zdrav Vestn. 2014;83:727–58.

Oparil S, Zaman MA, Calhoun DA. Pathogenesis of hypertension. Ann Intern Med. 2003 Nov;139(9):761–76. PMID:14597461

Rossi GP, Seccia TM, Pessina AC. Clinical use of laboratory tests for the identification of secondary forms of arterial hypertension. Crit Rev Clin Lab Sci. 2007;44(1):1–85. PMID:17175520

Kocjan T. Rational Approach to a Patient with Suspected Primary Aldosteronism. In: Lew JI, ed. Clinical Management of Adrenal Tumors [Internet]. InTech; 2017 [cited 2018 Apr 4]. Available from:

Funder JW, Carey RM, Mantero F, Murad MH, Reincke M, Shibata H, et al. The Management of Primary Aldosteronism: Case Detection, Diagnosis, and Treatment: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2016 May;101(5):1889–916. PMID:26934393

Young WF. Primary aldosteronism: renaissance of a syndrome. Clin Endocrinol (Oxf). 2007 May;66(5):607–18. PMID:17492946

Funder JW. Primary aldosteronism and salt. Pflugers Arch. 2015 Mar;467(3):587–94. PMID:25502114

Monticone S, Burrello J, Tizzani D, Bertello C, Viola A, Buffolo F, et al. Prevalence and Clinical Manifestations of Primary Aldosteronism Encountered in Primary Care Practice. J Am Coll Cardiol. 2017 Apr;69(14):1811–20. PMID:28385310

Hannemann A, Wallaschofski H. Prevalence of primary aldosteronism in patient’s cohorts and in population-based studies—a review of the current literature. Horm Metab Res. 2012 Mar;44(3):157–62. PMID:22135219

Monticone S, Viola A, Rossato D, Veglio F, Reincke M, Gomez-Sanchez C, et al. Adrenal vein sampling in primary aldosteronism: towards a standardised protocol. Lancet Diabetes Endocrinol. 2015 Apr;3(4):296–303. PMID:24831990

Steichen O, Zinzindohoué F, Plouin PF, Amar L. Outcomes of adrenalectomy in patients with unilateral primary aldosteronism: a review. Horm Metab Res. 2012 Mar;44(3):221–7. PMID:22395801

Williams TA, Lenders JW, Mulatero P, Burrello J, Rottenkolber M, Adolf C, et al.; Primary Aldosteronism Surgery Outcome (PASO) investigators. Outcomes after adrenalectomy for unilateral primary aldosteronism: an international consensus on outcome measures and analysis of remission rates in an international cohort. Lancet Diabetes Endocrinol. 2017 Sep;5(9):689–99. PMID:28576687

Mulatero P, Milan A, Fallo F, Regolisti G, Pizzolo F, Fardella C, et al. Comparison of confirmatory tests for the diagnosis of primary aldosteronism. J Clin Endocrinol Metab. 2006 Jul;91(7):2618–23. PMID:16670162

Kempers MJ, Lenders JW, van Outheusden L, van der Wilt GJ, Schultze Kool LJ, Hermus AR, et al. Systematic review: diagnostic procedures to differentiate unilateral from bilateral adrenal abnormality in primary aldosteronism. Ann Intern Med. 2009 Sep;151(5):329–37. PMID:19721021

Moors M, Williams TA, Deinum J, Eisenhofer G, Reincke M, Lenders JW. Steroid Hormone Production in Patients with Aldosterone Producing Adenomas. Horm Metab Res. 2015 Dec;47(13):967–72. PMID:26667800

Ceolotto G, Antonelli G, Maiolino G, Cesari M, Rossitto G, Bisogni V, et al. Androstenedione and 17-α-Hydroxyprogesterone Are Better Indicators of Adrenal Vein Sampling Selectivity Than Cortisol. Hypertension. 2017 Aug;70(2):342–6. PMID:28584010

Dekkers T, Deinum J, Schultzekool LJ, Blondin D, Vonend O, Hermus AR, et al. Plasma metanephrine for assessing the selectivity of adrenal venous sampling. Hypertension. 2013 Dec;62(6):1152–7. PMID:24082051

Strajina V, Al-Hilli Z, Andrews JC, Bancos I, Thompson GB, Farley DR, et al. Primary aldosteronism: making sense of partial data sets from failed adrenal venous sampling-suppression of adrenal aldosterone production can be used in clinical decision making. Surgery. 2018 Apr;163(4):801–6. PMID:29174432

Dekkers T, Prejbisz A, Kool LJ, Groenewoud HJ, Velema M, Spiering W, et al.; SPARTACUS Investigators. Adrenal vein sampling versus CT scan to determine treatment in primary aldosteronism: an outcome-based randomised diagnostic trial. Lancet Diabetes Endocrinol. 2016 Sep;4(9):739–46. PMID:27325147

Rossi GP, Funder JW. Adrenal Venous Sampling Versus Computed Tomographic Scan to Determine Treatment in Primary Aldosteronism (The SPARTACUS Trial): A Critique. Hypertension. 2017 Mar;69(3):396–7. PMID:28137983

Bardet S, Chamontin B, Douillard C, Pagny JY, Hernigou A, Joffre F, et al. SFE/SFHTA/AFCE consensus on primary aldosteronism, part 4: subtype diagnosis. Ann Endocrinol (Paris). 2016 Jul;77(3):208–13. PMID:27036860

Powlson AS, Gurnell M, Brown MJ. Nuclear imaging in the diagnosis of primary aldosteronism. Curr Opin Endocrinol Diabetes Obes. 2015 Jun;22(3):150–6. PMID:25871964

Burton TJ, Mackenzie IS, Balan K, Koo B, Bird N, Soloviev DV, et al. Evaluation of the sensitivity and specificity of (11)C-metomidate positron emission tomography (PET)-CT for lateralizing aldosterone secretion by Conn’s adenomas. J Clin Endocrinol Metab. 2012 Jan;97(1):100–9. PMID:22112805

Ouyang J, Hardy R, Brown M, Helliwell T, Gurnell M, Cuthbertson DJ. 11C-metomidate PET-CT scanning can identify aldosterone-producing adenomas after unsuccessful lateralisation with CT/MRI and adrenal venous sampling. J Hum Hypertens. 2017 Jul;31(7):483–4. PMID:28276424

How to Cite
Kukman S, Šmid T, Kocjan T. Pathways and dead ends in the diagnostics of primary aldosteronism. ZdravVestn [Internet]. 4Mar.2019 [cited 22Sep.2019];88(1-2):61-0. Available from:
Case report, short scientific article