Primary hyperaldosteronism CT scan Findings

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Syed Hassan A. Kazmi BSc, MD [2]

Overview

Adrenal CT scan may be helpful in the diagnosis of primary hyperaldosteronism. Findings on CT scan suggestive of primary hyperaldosteronism are signal intensity near to <10 HU, no contrast enhancement, and non-calcified lesion in adrenal gland.

CT scan

• Adrenal CT scan may be helpful in the diagnosis of primary hyperaldosteronism.
• Adrenal adenomas may display the following features on CT scanning:
  • Functional adenomas are homogeneous and hypodense.
  • The signal intensity may be near to <10 HU.
  • No contrast enhancement
  • Non-calcified

• A high-resolution CT (HRCT) scan with contrast, has a high sensitivity (78%) and specificity (75%) for detection of adrenal masses (including aldosterone producing adenomas-APAs)
• CT scan is best when used for adrenal adenomas >2 cm but accuracy decreases if the mass is <1 cm.
• A unilateral lesion exceeding 4 cm suggests possible carcinoma
• Moreover, it cannot distinguish between a functional APA and a non-secreting adrenal adenoma (incidentaloma).
• If CT findings are negative, selective adrenal venous sampling for aldosterone or a dexamethasone suppressed iodocholesterol adrenal scan may identify the tumor.

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