Horm Metab Res 2017; 49(12): 922-928
DOI: 10.1055/s-0043-122602
© Georg Thieme Verlag KG Stuttgart · New York

Subtyping of Patients with Primary Aldosteronism: An Update

Jacques W. M. Lenders
1  Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
2  Department of Internal Medicine III, Technische Universität Dresden, Dresden, Germany
Graeme Eisenhofer
3  Institute of Clinical Chemistry and Laboratory Medicine, Technische Universität Dresden, Dresden, Germany
Martin Reincke
4  Medizinische Klinik und Poliklinik IV, Klinikum der Ludwig-Maximilians-Universität München, Munich, Germany
› Author Affiliations
Further Information

Publication History

received 27 September 2017

accepted 05 November 2017

Publication Date:
04 December 2017 (online)


Primary aldosteronism (PA) comprises two main subtypes: unilateral aldosteronism, mainly caused by aldosterone-producing adenoma; and bilateral adrenal hyperplasia. Establishing the correct subtype in patients with PA is indispensible for choice of treatment. In addition to established methods, alternative tests are evolving for subtyping. Computed tomography (CT) and adrenal venous sampling (AVS) are currently recommended in the guidelines for the diagnostic work-up of patients with PA. CT cannot be used as a stand-alone test for subtyping because of its limited accuracy but may be used in combination with other tests such as AVS or functional imaging. Nevertheless CT remains mandatory to exclude adrenocortical carcinoma. AVS provides the most accurate test to detect excessive secretion of aldosterone from an adrenal mass but has several practical limitations and disadvantages. Therefore, alternative non-invasive and patient-friendly methods are required to determine the need for adrenalectomy. Functional imaging with specific molecular positron emission tomographic ligands is a potential alternative method that may replace AVS for subclassifying patients with PA. The results of preliminary studies of 11C-metomidate are promising but ligands incorporating radionuclides with longer half-lives that selectively bind to CYP11B2 are needed. Steroid profiling provides another method for subtyping and selecting patients for adrenalectomy, but this technology is in its infancy and prospective outcome-based studies are required to determine if this technique may provide an alternative to AVS.