DEXAMETHASONE-MODIFIED ADRENAL SCINTISCAN IN HYPORENINEMIC ALDOSTERONISM (TUMOR VERSUS HYPERPLASIA) - COMPARISON WITH ADRENAL VENOGRAPHY AND ADRENAL VENOUS ALDOSTERONE

  • 1 January 1976
    • journal article
    • research article
    • Vol. 88  (5) , 841-856
Abstract
The dexamethasone-modified adrenal scintiscan (SS), a noninvasive procedure, is described for the preoperative distinction between primary aldosteronism (aldosterone-producing adenoma) and idiopathic aldosteronism (bilateral hyperplasia), and for the preoperative localization of aldosterone-producing adenomas. This procedure was done in 17 subsequently proved cases of primary aldosteronism and 9 cases (4 unexplored) of idiopathic aldosteronism. In the tumor cases, it indicated correctly the side of the tumor in 88%. It was correct in predicting the existence of bilateral hyperplasia in all 5 cases explored. It produced the same response in 4 more patients believed to have bilateral hyperplasia, in which surgical exploration was not done. Many of the same patients also had standard adrenal SS, adrenal venography and determinations of aldosterone in adrenal venous blood. These results are compared with those of the dexamethasone scintiscan (DS). In tumor localization, the 88% figure for the DS was only moderately better than that of the other 3 (71%, SS; 80%, venography; 80%, adrenal venous aldosterone levels). In predicting bilateral hyperplasia, the DS was 100% correct, as were the levels of aldosterone in adrenal venous blood. The SS and adrenal venography failed in bilateral hyperplasia and gave many false positive results indicating tumors. The DS, a relatively simple outpatient procedure, appears to be at least as effective, in lateralizing tumors and distinguishing between tumor and bilateral hyperplasia, as the more difficult, expensive and sometimes hazardous invasive procedure of bilateral adrenal vein catheterization.

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