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Diagnosis and Treatment > Signs and Symptoms > Cholecystitis

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G Leksic Division of Endocrinology and Diabetes, Department of Internal Medicine

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A M Alduk Department of Radiology, University Hospital Centre Zagreb, Zagreb, Croatia

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V Molnar Division of Endocrinology and Diabetes, Department of Internal Medicine

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A Haxhiu Division of Endocrinology and Diabetes, Department of Internal Medicine

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A Balasko Division of Endocrinology and Diabetes, Department of Internal Medicine

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N Knezevic Department of Urology, Department of Internal Medicine, University Hospital Centre Zagreb, School of Medicine, University of Zagreb, Zagreb, Croatia

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T Dusek Division of Endocrinology and Diabetes, Department of Internal Medicine, University Hospital Centre Zagreb, School of Medicine, University of Zagreb, Zagreb, Croatia

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D Kastelan Division of Endocrinology and Diabetes, Department of Internal Medicine, University Hospital Centre Zagreb, School of Medicine, University of Zagreb, Zagreb, Croatia

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Summary

Primary aldosteronism (PA) is characterised by aldosterone hypersecretion and represents a common cause of secondary hypertension. During diagnostic evaluation, it is essential to determine the aetiology of PA since the treatment of unilateral and bilateral disease differs significantly. Adrenal vein sampling (AVS) has been implemented as a gold standard test for the diagnosis of PA subtype. However, due to the AVS complexity, costs and limited availability, many patients with PA are being treated based on the computed tomography (CT) findings. In this article, we present two patients with discrepant CT and AVS results, demonstrating that AVS is the only reliable method for localising the source of aldosterone excess.

Learning points:

  • CT is an unreliable method for distinguishing aldosterone-producing adenoma (APA) from bilateral adrenal hyperplasia (BAH).

  • CT can be misleading in defining lateralisation of the aldosterone excess in case of unilateral disease (APA).

  • AVS is the gold standard test for defining the PA subtype.

Taxonomy:
Clinical Overview, Gland/Organ, Adrenal, Topic, Adrenal, Cardiovascular endocrinology, Hormone, Aldosterone, Condition/ Syndrome, Hyperaldosteronism, Hypertension, Hypokalaemia, Patient Demographics, Age, Adult, Gender, Male, Ethnicity, White, Country of Treatment, Croatia, Diagnosis and Treatment, Signs and Symptoms, Cholecystitis, Gallstones, Headache, Hypertension, Hypokalaemia, Investigation, Adrenal venous sampling, Aldosterone (plasma), Aldosterone to renin ratio, Blood pressure, BMI, Cortisol (plasma), CT scan, Histopathology, Potassium, Intervention, Adrenalectomy, Laparoscopic adrenalectomy, Medication, Angiotensin receptor antagonists, Indapamide, Ramipril, Related Disciplines, Cardiology, General practice, Surgery, Publication Details, Case Report Type, Unique/unexpected symptoms or presentations of a disease
DOI:
https://doi.org/10.1530/EDM-19-0018
Volume/Issue:
Volume 2019: Issue 1
Open access