Preoperative localization of aldosterone-producing adenomas. An analysis of the efficiency of different diagnostic procedures made from 11 cases and from a review of the literature.

The efficiency of six different methods available for topographical diagnosis of primary aldosteronism was analysed in retrospect from 11 surgically verified cases and by an analysis of 360 cases reported in the literature. Differentiation between hyperplasia and adenoma was most safely predicted by monitoring the diurnal rhythm of plasma aldosterone and its reaction to posture. Adrenal vein catheterization with aldosterone determinations was helpful in establishing the presence of hyperplasia in approximately 70% of these cases. Correct localization of aldosterone-producing adenomas was made in more than 90% by vein catheterization while venography and radio-cholesterol scintigraphy had lower diagnostic accuracy. It is therefore suggested that determination of plasma aldosterone both by vein catheterization and by peripheral monitoring should be used ahead of other diagnostic procedures for topographical examinations in primary aldosteronism.