ABSTRACT
UNLABELLED: The prevalence of hypertension resistant to treatment to indicate for renal denervation. OBJECTIVE: To evaluate the efficiency for imaging the adrenal glands with an abdominal CT scan in first-line in subjects with resistant hypertension suspected to have an adrenal cause. METHODS: On 75 hypertensive patients uncontrolled by at least a combination therapy, but suspected to have secondary hypertension due to adrenal cause, an abdominal CT scan was performed in first intention. In all subjects, an exploration of the renin-aldosteron axis in standardized conditions, a 24-hour urinary cortisol and a WHO recommended biological analysis were also performed. RESULTS: An abnormal morphology of adrenal was found by abdominal CT in 64% of patients. The abnormalities observed were: bilateral hyperplasia (27%), unilateral adenoma (15%), unilateral hyperplasia (15%), bilateral adenoma (7%). Abnormal biological and/or hormonal tests for adrenal disease were found in 29% of patients, with a primary aldosteronism (A/R corrected>23) in 11% or K less than 3.5mmol/L in 20%. According to the assessment conducted in first-line, indication to spironolactone is selected in 48% of patients investigated with CT as first-line and in 17% of patients investigated with biological tests (P<0.01) while the indication to adrenal surgery would be held in 15% and 11% of patients respectively. CONCLUSION: In a population of subjects with uncontrolled hypertension in which an adrenal cause is suspected, achieving a first-line abdominal CT leads to adrenal abnormality observed in 64% of patients while a specific biological abnormality is noted in 29% of subjects. This study shows that assessment that starts with an abdominal CT scan allows to indicate treatment with spironolactone more frequently than when the first assessment is limited to a biological investigation.
Subject(s)
Adrenal Cortex Neoplasms/diagnostic imaging , Adrenocortical Adenoma/diagnostic imaging , Hydrocortisone/urine , Hyperaldosteronism/diagnostic imaging , Hypertension/diagnostic imaging , Hypertension/etiology , Tomography, X-Ray Computed , Adrenal Cortex Neoplasms/complications , Adrenal Glands/diagnostic imaging , Adrenal Glands/metabolism , Adrenal Glands/pathology , Adrenocortical Adenoma/complications , Adult , Aged , Antihypertensive Agents/therapeutic use , Biomarkers/urine , Diagnosis, Differential , Female , Hospitals, University , Humans , Hyperaldosteronism/complications , Hyperaldosteronism/etiology , Hyperplasia , Hypertension/drug therapy , Male , Middle Aged , Predictive Value of Tests , Risk Assessment , Sensitivity and SpecificityABSTRACT
Functioning endocrine pancreatic tumors in multiple endocrine neoplasia type 1 (MEN1) are rare. We present a case of a symptomatic neuroendocrine tumor in a 27-year old woman. The identification of the nature of the neuroendocrine tumors was difficult despite the use of a wide range of diagnostic procedures. This case is interesting in many ways: this is an exceptional illustration of MEN 1 with vipoma associated with calcitonin secretion and it is also a good example of the benefits and limitations of each diagnostic procedure in the heterogeneous group of neuroendocrine tumors.
