The Journal of clinical endocrinology and metabolism · 2026
Aldosterone synthase expression vs cross-sectional imaging in lateralized primary aldosteronism.
СтатьяНазвание и аннотация: Перевод в очереди
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Mermejo Livia M, Liu Yueting, Caoili Elaine, van Rooyen Desmaré, Rege Juilee, Udager Aaron, Rainey William E, Vibhatavata Peeradon, Turcu Adina F
Аннотация
CONTEXT: Adrenal vein sampling is the standard of care for guiding surgery in primary aldosteronism (PA). Because of its technical complexity and limited availability, however, many centers still use cross-sectional imaging for surgical guidance.
DESIGN: Single referral-center retrospective cohort study of patients with PA who underwent unilateral adrenalectomy between 2012 and 2024. Blinded cross-sectional imaging interpretation was corroborated with aldosterone synthase (CYP11B2) immunohistochemistry (IHC) of formalin-fixed paraffin-embedded adrenal tissue.
RESULTS: Of 173 patients, age 52.6 ± 11.8 years, 119 (68.8%) were men, 134 (77.5%) White, 30 (17.3%) Black, and 9 (5.2%) other races. CYP11B2 IHC identified a single aldosterone-producing adenoma (APA) or nodule (APN) in 87 (50.3%) and 38 (22.0%) patients, respectively; multiple CYP11B2-positive foci in 45 (26.0%) patients, and no CYP11B2-positive lesions in 3 patients. A single corresponding APA or APN on both IHC and imaging was found in only 53/173 (31%) patients, and an additional 38/173 (22%) patients also had adrenal thickening. Discrepant IHC-imaging findings were observed in 82 (47.4%) patients, including (1) additional nodule(s) on imaging (ipsilateral nonfunctional adenoma [n = 21], bilateral nodules [n = 29], or contralateral nodule(s) [n = 6]); (2) normal adrenals (n = 2) or unilateral adrenal hyperplasia (n = 4), but discrete CYP11B2-positive foci on IHC; and (3) corresponding APA/APN on imaging-IHC with additional CYP11B2-positive area(s) (n = 20). Patients with IHC-imaging concordance had the highest proportion of women and KCNJ5 mutations, while CACNA1D mutations were most frequent in the discordant group.
CONCLUSION: Even in patients with lateralized PA, IHC mapping of aldosterone sources corresponded with imaging findings in approximately half of the cases. These data caution against targeted therapy guided by cross-sectional imaging.
DESIGN: Single referral-center retrospective cohort study of patients with PA who underwent unilateral adrenalectomy between 2012 and 2024. Blinded cross-sectional imaging interpretation was corroborated with aldosterone synthase (CYP11B2) immunohistochemistry (IHC) of formalin-fixed paraffin-embedded adrenal tissue.
RESULTS: Of 173 patients, age 52.6 ± 11.8 years, 119 (68.8%) were men, 134 (77.5%) White, 30 (17.3%) Black, and 9 (5.2%) other races. CYP11B2 IHC identified a single aldosterone-producing adenoma (APA) or nodule (APN) in 87 (50.3%) and 38 (22.0%) patients, respectively; multiple CYP11B2-positive foci in 45 (26.0%) patients, and no CYP11B2-positive lesions in 3 patients. A single corresponding APA or APN on both IHC and imaging was found in only 53/173 (31%) patients, and an additional 38/173 (22%) patients also had adrenal thickening. Discrepant IHC-imaging findings were observed in 82 (47.4%) patients, including (1) additional nodule(s) on imaging (ipsilateral nonfunctional adenoma [n = 21], bilateral nodules [n = 29], or contralateral nodule(s) [n = 6]); (2) normal adrenals (n = 2) or unilateral adrenal hyperplasia (n = 4), but discrete CYP11B2-positive foci on IHC; and (3) corresponding APA/APN on imaging-IHC with additional CYP11B2-positive area(s) (n = 20). Patients with IHC-imaging concordance had the highest proportion of women and KCNJ5 mutations, while CACNA1D mutations were most frequent in the discordant group.
CONCLUSION: Even in patients with lateralized PA, IHC mapping of aldosterone sources corresponded with imaging findings in approximately half of the cases. These data caution against targeted therapy guided by cross-sectional imaging.