More than 50 years after its introduction, AVS remains controversial as an invasive, expensive and a technically challenging method with successful bilateral catheterization obtained in only about 75% of cases. 4, 8, 9Īll other surgical candidates should proceed to adrenal vein sampling (AVS), which is regarded as the gold standard to demonstrate lateralization and to avoid unnecessary or inappropriate adrenalectomy. 8 The only exception are infrequent younger patients below 35 years of age with florid disease and a clear one-sided adrenal adenoma with normal contralateral gland. 4, 7 In most patients CT cannot accurately distinguish between unilateral and bilateral forms, and may even lead to inappropriate treatment of primary aldosteronism.

an aldosterone producing adenoma) declines with patient age. 4 However, because of increasing prevalence of nonfunctioning adrenal incidentalomas, the reliability of CT in localizing unilateral disease (e.g. Adrenal computed tomography (CT) (or magnetic resonance imaging (MRI)) should be the first test in the subtype evaluation of primary aldosteronism and to exclude adrenocortical carcinoma. Therefore, a crucial part of diagnostic workup in primary aldosteronism is to correctly determine which patients have unilateral disease and could pursue surgical cure. 4, 5 Longterm medical treatment with mineralocorticoid receptor antagonists is not only more expensive and less convenient, but it might also have worse outcomes overall. 1, 2, 3 Amongst available targeted treatment, the preferred therapeutic option is unilateral laparoscopic adrenalectomy, which can normalize or decrease blood pressure in most patients with proven unilateral disease.

1 Autonomous and excessive secretion of aldosterone from one or both adrenal glands in patients with primary aldosteronism causes significantly higher cardiovascular risk and more pronounced renal damage compared to equally severe essential hypertension. Primary aldosteronism is the most common form of secondary hypertension, with a prevalence of 5.9% among hypertensive patients in primary care practice.

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