Systematic review: diagnostic procedures to differentiate unilateral from bilateral adrenal abnormality in primary aldosteronism. Export

@article{citeulike:5711775, abstract = {BACKGROUND: Computed tomography (CT), magnetic resonance imaging (MRI), and adrenal vein sampling (AVS) are used to distinguish unilateral from bilateral increased aldosterone secretion as a cause of primary aldosteronism. This distinction is crucial because unilateral primary aldosteronism can be treated surgically, whereas bilateral primary aldosteronism should be treated medically. PURPOSE: To determine the proportion of patients with primary aldosteronism whose CT or MRI results with regard to unilateral or bilateral adrenal abnormality agreed or did not agree with those of AVS. DATA SOURCES: PubMed, MEDLINE, EMBASE, and Cochrane Library, 1977 to April 2009. STUDY SELECTION: Studies describing adults with primary aldosteronism who underwent CT/MRI and AVS were included. Of 472 initially identified studies, 38 met the selection criteria; extractable data were available for 950 patients. DATA EXTRACTION: The CT/MRI result was considered accurate when AVS showed unilaterally increased aldosterone secretion on the same side as the abnormality seen on CT/MRI or when AVS showed symmetric aldosterone secretion and CT/MRI revealed bilateral or no unilateral abnormality. DATA SYNTHESIS: In 37.8\% of patients (359 of 950), CT/MRI results did not agree with AVS results. If only CT/MRI results had been used to determine lateralization of an adrenal abnormality, inappropriate adrenalectomy would have occurred in 14.6\% of patients (where AVS showed a bilateral problem), inappropriate exclusion from adrenalectomy would have occurred in 19.1\% (where AVS showed unilateral secretion), and adrenalectomy on the wrong side would have occurred in 3.9\% (where AVS showed aldosterone secretion on the opposite side). LIMITATION: The lack of follow-up data in the included articles made it impossible to confirm that adrenalectomies were performed appropriately. CONCLUSION: When AVS is used as the criterion standard test for diagnosing laterality of aldosterone secretion in patients with primary aldosteronism, CT/MRI misdiagnosed the cause of primary aldosteronism in 37.8\% of patients. Relying only on CT/MRI may lead to inappropriate treatment of patients with primary aldosteronism.}, author = {Kempers, Marlies J. and Lenders, Jacques W. and van Outheusden, Lieke and van der Wilt, Gert Jan J. and Schultze Kool, Leo J. and Hermus, Ad R. and Deinum, Jaap}, citeulike-article-id = {5711775}, citeulike-linkout-0 = {http://view.ncbi.nlm.nih.gov/pubmed/19721021}, citeulike-linkout-1 = {http://www.hubmed.org/display.cgi?uids=19721021}, day = {1}, issn = {1539-3704}, journal = {Annals of internal medicine}, keywords = {adrenal}, month = {September}, number = {5}, pages = {329--337}, posted-at = {2009-09-03 06:33:57}, priority = {2}, title = {Systematic review: diagnostic procedures to differentiate unilateral from bilateral adrenal abnormality in primary aldosteronism.}, url = {http://view.ncbi.nlm.nih.gov/pubmed/19721021}, volume = {151}, year = {2009} }

TY - JOUR ID - citeulike:5711775 L3 - citeulike-article-id:5711775 N2 - BACKGROUND: Computed tomography (CT), magnetic resonance imaging (MRI), and adrenal vein sampling (AVS) are used to distinguish unilateral from bilateral increased aldosterone secretion as a cause of primary aldosteronism. This distinction is crucial because unilateral primary aldosteronism can be treated surgically, whereas bilateral primary aldosteronism should be treated medically. PURPOSE: To determine the proportion of patients with primary aldosteronism whose CT or MRI results with regard to unilateral or bilateral adrenal abnormality agreed or did not agree with those of AVS. DATA SOURCES: PubMed, MEDLINE, EMBASE, and Cochrane Library, 1977 to April 2009. STUDY SELECTION: Studies describing adults with primary aldosteronism who underwent CT/MRI and AVS were included. Of 472 initially identified studies, 38 met the selection criteria; extractable data were available for 950 patients. DATA EXTRACTION: The CT/MRI result was considered accurate when AVS showed unilaterally increased aldosterone secretion on the same side as the abnormality seen on CT/MRI or when AVS showed symmetric aldosterone secretion and CT/MRI revealed bilateral or no unilateral abnormality. DATA SYNTHESIS: In 37.8% of patients (359 of 950), CT/MRI results did not agree with AVS results. If only CT/MRI results had been used to determine lateralization of an adrenal abnormality, inappropriate adrenalectomy would have occurred in 14.6% of patients (where AVS showed a bilateral problem), inappropriate exclusion from adrenalectomy would have occurred in 19.1% (where AVS showed unilateral secretion), and adrenalectomy on the wrong side would have occurred in 3.9% (where AVS showed aldosterone secretion on the opposite side). LIMITATION: The lack of follow-up data in the included articles made it impossible to confirm that adrenalectomies were performed appropriately. CONCLUSION: When AVS is used as the criterion standard test for diagnosing laterality of aldosterone secretion in patients with primary aldosteronism, CT/MRI misdiagnosed the cause of primary aldosteronism in 37.8% of patients. Relying only on CT/MRI may lead to inappropriate treatment of patients with primary aldosteronism. IS - 5 JF - Annals of internal medicine SN - 1539-3704 EP - 337 TI - Systematic review: diagnostic procedures to differentiate unilateral from bilateral adrenal abnormality in primary aldosteronism. VL - 151 SP - 329 KW - adrenal AU - Kempers, Marlies AU - Lenders, Jacques AU - van Outheusden, Lieke AU - van der Wilt, Gert Jan AU - Schultze Kool, Leo AU - Hermus, Ad AU - Deinum, Jaap PY - 2009/09/01/ UR - http://view.ncbi.nlm.nih.gov/pubmed/19721021 ER -