Evolution of computed tomography-detectable adrenal nodules in patients with bilateral primary aldosteronism

Computed tomography (CT) appearance of adrenals in primary aldosteronism (PA) ranges from normal to bilateral diffuse enlargement or nodular glands. Idiopathic hyperaldosteronism (IHA) due to bilateral autonomous production of aldosterone (bilateral PA) is the most common subtype of PA, accounting for 50–70 % of PA patients. Regardless of adrenal image findings, IHA is diagnosed by adrenal venous sampling (AVS) in PA patients who do not show lateralization of aldosterone secretion, and is treated by long-term medical therapy using mineralocorticoid receptor antagonists. The other common PA subtypes, aldosterone-producing adenoma (APA) and unilateral adrenal hyperplasia, display lateralization of aldosterone secretion at AVS and are treated by unilateral adrenalectomy. Natural course of adrenal mass lesions in IHA patients has not yet been fully clarified. The aim of our study was to assess the over time evolution of CTdetectable adrenal nodule(s) in bilateral PA.