Radin D R, Manoogian C, Nadler J L
Department of Radiology, University of Southern California School of Medicine, Los Angeles 90033-1084.
AJR Am J Roentgenol. 1992 Mar;158(3):553-7. doi: 10.2214/ajr.158.3.1738993.
Twenty patients with primary hyperaldosteronism had endocrinologic and radiologic studies to distinguish aldosterone-producing adenoma from idiopathic hyperaldosteronism due to bilateral micro- or macronodular hyperplasia of the adrenal cortex. In addition to examination for changes in the plasma level of aldosterone associated with postural changes and measurement of the plasma level of 18-hydroxycorticosterone, all 20 patients had CT examination of the adrenal glands. In three patients with normal adrenal glands on CT and three patients with CT evidence of two solitary nodules, one in each adrenal gland, a diagnosis of idiopathic hyperaldosteronism was confirmed by endocrinologic findings (five patients) or 131I-6 beta-iodomethyl-19-norcholesterol (NP-59) adrenal scintigraphy (one patient). In nine patients with a solitary adrenal nodule on CT, a diagnosis of aldosterone-producing adenoma was confirmed by surgery (seven patients) or hormone sampling via the adrenal veins (two patients). However, in three patients with a solitary adrenal nodule on CT, a diagnosis of idiopathic hyperaldosteronism was suggested by endocrinologic findings (three patients) and confirmed by the results of NP-59 scintigraphy (two patients) or adrenal venous sampling (one patient). In addition, in two patients with CT evidence of three adrenal nodules (two in one gland, one in contralateral gland), a diagnosis of aldosterone-producing adenoma was suggested by endocrinologic findings in both patients and confirmed by surgery in one. Although high-resolution CT is highly accurate for the detection of aldosterone-producing adenoma, significant diagnostic errors can occur in patients with primary hyperaldosteronism if CT findings are not correlated with results of endocrinologic studies.
20例原发性醛固酮增多症患者接受了内分泌和放射学检查，以区分醛固酮瘤与因双侧肾上腺皮质微小结节或大结节增生所致的特发性醛固酮增多症。除了检查与体位改变相关的血浆醛固酮水平变化以及测定血浆18-羟皮质酮水平外，所有20例患者均接受了肾上腺CT检查。CT显示肾上腺正常的3例患者以及CT显示双侧肾上腺各有一个孤立结节的3例患者，通过内分泌检查结果（5例患者）或131I-6β-碘甲基-19-去甲胆固醇（NP-59）肾上腺闪烁显像（1例患者）确诊为特发性醛固酮增多症。CT显示有单个肾上腺结节的9例患者，通过手术（7例患者）或经肾上腺静脉采集激素样本（2例患者）确诊为醛固酮瘤。然而，CT显示有单个肾上腺结节的3例患者，根据内分泌检查结果（3例患者）提示为特发性醛固酮增多症，并经NP-59闪烁显像结果（2例患者）或肾上腺静脉采血（1例患者）得以证实。此外，2例CT显示有3个肾上腺结节（一侧肾上腺有2个，对侧肾上腺有1个）的患者，根据内分泌检查结果均提示为醛固酮瘤，其中1例经手术得以证实。尽管高分辨率CT对醛固酮瘤的检测具有很高的准确性，但在原发性醛固酮增多症患者中，如果CT检查结果不与内分泌检查结果相结合，仍可能出现明显的诊断错误。
