Endoscopic Ultrasound of the Adrenals in Primary Aldosteronism

Peter Herbert Kann1,5*, Joachim Nils Goebel1 , Jan Adelmeyer1 , Simona Bergmann1 , Verena Mann1 , Detlef Klaus Bartsch2 , Katharina Holzer2 , Anette Ramaswamy3 , Andreas Horst Mahnken4 and Anna Leonhardt1

Centre for Endocrinology, Diabetology and Osteology, Endocrine Laboratory, Philipp?s University and University Hospital Marburg, Germany 2 Department of Visceral, Thoracic and Vascular Surgery, Philipp?s University and University Hospital Marburg, Germany 3 Institute for Pathology, Philipp?s University and University Hospital Marburg, Germany 4 Clinic of Diagnostic and Interventional Radiology, Philipp?s University and University Hospital Marburg, Germany 5 German Centre for Endocrine Care, Frankfurt/Main, Germany

^*Correspondance to: Peter Herbert Kann 

 PDF  Full Text DOI: 10.25107/2474-1647.3097

Abstract

Background/Aim: It is a major challenge in the diagnosis of primary aldosteronism to identify patients with aldosterone producing adrenal adenoma which may benefit from surgical treatment (adrenalectomy/adenomectomy). Adrenal adenomas may be visualized by endoscopic ultrasound. However, a possible role and relevance of endoscopic ultrasound in the diagnostic process of primary aldosteronism has not been investigated systematically yet. Methods: We included 112 patients (48 females, 64 males, 54 ? 12 years) between 1997 to 2019 with positive screening test (aldosterone/renin-ratio) and arterial hypertension undergoing endoscopic ultrasound imaging of the adrenals into this study. Final diagnosis of aldosterone producing adenoma based on confirmation tests, imaging, selective blood sampling, histopathology and postsurgical improvement. Results: In 44 patients, diagnosis of aldosterone producing adrenal adenoma could finally be defined. Endoscopic ultrasound detected and localized 39/44 (89%) correctly (tumor diameter 15.6 ? 5.4 (5.7 to 26.0) mm). Computed tomography (n=26) localized correctly in 81%, magnetic resonance imaging (n=25) in 76%, and conventional sonography (n=19) in 32%. Endoscopic ultrasound was the only method localizing correctly in 8 cases (18%). Conclusion: Endoscopic ultrasound is a reliable and highly sensitive diagnostic tool in suspected aldosterone producing adrenal adenoma with a high negative predictive value. It can be useful to define patients which benefit from surgical treatment.

Keywords

Adenoma; Aldosterone; Conn?s disease; Endoscopic ultrasound; Imaging

Cite the article

Kann PH, Goebel JN, Adelmeyer J, Bergmann S, Mann V, Bartsch DK, et al. Endoscopic Ultrasound of the Adrenals in Primary Aldosteronism. Clin Surg. 2021; 6: 3097.