Predictive value of preoperative tests in discriminating bilateral adrenal hyperplasia from an aldosterone-producing adrenal adenoma

J Clin Endocrinol Metab. 2000 Dec;85(12):4526-33. doi: 10.1210/jcem.85.12.7086.


In primary hyperaldosteronism, discriminating bilateral adrenal hyperplasia (BAH) from an aldosterone-producing adenoma (APA) is important because adrenalectomy, which is usually curative in APA, is seldom effective in BAH. We analyzed the results from our most recent 7-yr series to evaluate the predictive value of preoperative noninvasive tests compared with adrenal vein sampling (AVS). Forty-eight patients with hypertensive hyperaldosteronism underwent bedside testing, computed tomography (CT) imaging, and AVS. Those in whom the results of AVS indicated APA underwent adrenalectomy. Twelve (30%) and 14 (34%) of 41 patients with APA had paradoxical falls with ambulation in plasma aldosterone concentration (PAC) and 18-hydroxycorticosterone (18-OH-B), respectively. Twenty-nine (70%) and 26 (65%) APA patients had a rise in PAC and 18-OH-B, respectively, as did all 8 BAH patients. Significant identifiers of BAH were supine PAC values less than 15 ng/dL (P: = 0.04), an increase greater than 60% (P: = 0.02) in PAC with ambulation, and supine 18-OH-B values less than 60 ng/dL (P: = 0.04). CT imaging alone was not predictive for BAH or APA. In our population, patients with a positive bedside test result (e.g. a fall in PAC and/or 18-OH-B) and a unilateral adrenal nodule on CT (10 of 41 patients) could have proceeded directly to adrenalectomy for APA. However, a positive bedside test result with a negative CT or a negative bedside test result regardless of CT findings required AVS to confirm the diagnosis and site of disease.

Publication types

  • Clinical Trial

MeSH terms

  • Adenoma / diagnosis*
  • Adenoma / diagnostic imaging
  • Adenoma / metabolism
  • Adrenal Gland Neoplasms / diagnosis*
  • Adrenal Gland Neoplasms / diagnostic imaging
  • Adrenal Gland Neoplasms / metabolism
  • Adrenal Hyperplasia, Congenital / diagnosis*
  • Adrenal Hyperplasia, Congenital / diagnostic imaging
  • Adrenal Hyperplasia, Congenital / metabolism
  • Adrenalectomy
  • Adrenocorticotropic Hormone / blood
  • Aldosterone / blood
  • Aldosterone / metabolism*
  • Diagnosis, Differential
  • Female
  • Humans
  • Hyperaldosteronism / diagnosis*
  • Hyperaldosteronism / etiology
  • Male
  • Middle Aged
  • Phytohemagglutinins / metabolism
  • Point-of-Care Systems
  • Posture / physiology
  • Tomography, X-Ray Computed
  • Walking / physiology


  • Phytohemagglutinins
  • Aldosterone
  • Adrenocorticotropic Hormone