Purpose: To evaluate the diagnostic accuracy of the 131I-6β-iodomethyl-19-norcholesterol (NP-59) adrenal scintigraphy for the subtyping diagnosis of primary aldosteronism (PA), considering as gold standard for the diagnosis of unilateral PA (UPA), either the results of the adrenal venous sampling (AVS) or the outcome after adrenalectomy. Methods: A retrospective multicenter study was performed on PA patients from 14 Spanish tertiary hospitals who underwent NP-59 scintigraphy with an available subtyping diagnosis. Patients were classified as UPA if biochemical cure was achieved after adrenalectomy or/and if an AVS lateralization index > 4 with ACTH stimulation or >2 without ACTH stimulation was observed. Patients were classified as having bilateral PA (BPA) if the AVS lateralization index was ≤4 with ACTH or ≤2 without ACTH stimulation or if there was evidence of bilateral adrenal nodules >1 cm in each adrenal gland detected by CT/MRI. Results: A total of 86 patients with PA were included (70.9% (n = 61) with UPA and 29.1% (n = 25) with BPA). Based on the NP-59 scintigraphy results, 16 patients showed normal suppressed adrenal gland uptake, and in the other 70 cases, PA was considered unilateral in 49 patients (70%) and bilateral in 21 (30%). Based on 59-scintigraphy results, 10.4% of the patients with unilateral uptake had BPA, and 27.3% of the cases with bilateral uptake had UPA. The AUC of the ROC curve of the NP-59 scintigraphy for PA subtyping was 0.812 [0.707–0.916]. Based on the results of the CT/MRI and NP-59 scintigraphy, only 6.7% of the patients with unilateral uptake had BPA, and 24% of the cases with bilateral uptake had UPA. The AUC of the ROC curve of the model combining CT/MRI and 59-scintigraphy results for subtyping PA was 0.869 [0.782–0.957]. Conclusion: The results of NP-59 scintigraphy in association with the information provided by the CT/MRI may be useful for PA subtyping. However, their diagnostic accuracy is only moderate. Therefore, it should be considered a second-line diagnostic tool when AVS is not an option.

Purpose To evaluate whether the clinical, biochemical and radiological features of patients with primary aldosteronism (PA) can predict both main subtypes of PA. Methods A retrospective multicenter study of PA patients followed in 27 Spanish tertiary hospitals (SPAIN-ALDO Register). Only patients with confirmed unilateral or bilateral PA based on adrenal venous sampling (AVS) and/or postsurgical biochemical cure after adrenalectomy were included. Supervised regression techniques were used for model development. Results 328 patients [270 unilateral PA (UPA), 58 bilateral PA (BPA)] were included. The area under the curve (AUC) for aldosterone/potassium ratio and aldosterone responses following saline infusion test were 0.602 [95%CI 0.520 to 0.684] and 0.574 [95% CI 0.446–0.701], respectively, to differentiate UPA from BPA. The AUC was 0.825 [95% 0.764–0.886] when the prediction model with seven parameters – comorbidities (dyslipidemia, cerebrovascular disease, sleep apnea syndrome [SAS]), systolic blood pressure (SBP), plasma aldosterone levels (PAC), hypokalemia and unilateral adrenal nodule >1 cm and normal contralateral adrenal gland on CT/MRI – was used. In patients without comorbidities, hypokalemia, SBP > 160 mmHg, PAC > 40 ng/dL, and unilateral adrenal lesions were associated with a likelihood of having a UPA of 98.5%. The chance of BPA was higher in individuals with comorbidities, SBP < 140 mmHg, normokalemia, low PAC levels, and no adrenal tumors on the CT/MRI (91.5%). Conclusion A combination of high PAC, SBP > 160 mmHg, low serum potassium, a unilateral adrenal nodule>1 cm and no comorbidities could predict a UPA with a 98.5% accuracy.

Purpose To determine the rate of genetic testing for familial hyperaldosteronism (FH) in the SPAIN-ALDO Registry and to describe the clinical characteristics of patients with FH. In addition, a literature review of reports of FH cases was performed. Methods A retrospective multicenter study of primary aldosteronism (PA) in patients followed in 35 Spanish tertiary hospitals (SPAIN-ALDO Registry). Results Twenty-five of the 855 patients (3%) with PA included in the registry underwent genetic testing for FH, with complete results available in only 24 patients. However, we found that there were 57 patients who met the criteria for performing a genetic study of PA. Only 8 out of these 57 patients were genetically tested (14.0%), while the reasons to perform a genetic study in the remaining 9 genetically studied cases were quite heterogeneous. A positive result for FH was found only in one case for FH type III (KCNJ5 pathogenic variant). A systematic review of the literature was performed and identified a total of 25 articles reporting 246 patients with FH type I; 12 articles reporting 72 patients with FH type II; 14 articles reporting 29 cases of FH type III and 3 articles reporting 12 patients with FH type IV. Conclusion The genetic study of familial hyperaldosteronism is often scarce in real-world clinical practice, as 86% of patients with criteria to undergo genetic study were not evaluated in our cohort. Nevertheless, FH is an uncommon cause of PA, representing only 0.2% of cases in the SPAIN-ALDO Registry, although its prevalence may be as high as 4% among suspected cases might be studied.

Summary Introduction: The psoas muscle index (PMI) and the skeletal mass index (SMI), as determined by computed tomography (CT), are the reference methods for assessing muscle mass. An alternative method is to measure the area of the rectus femoris muscle using ultrasonography (US).Objective : The objective of this study is twofold: firstly, to assess whether ultrasound imaging of the rectus femoris has an adequate correlation with psoas muscle index (PMI) and skeletal mass index (SMI) measurements obtained from computed tomography (CT) scans of oncosurgical patients at the L3 level; and secondly, to establish a cut-off point for diagnosing low muscle mass using this ultrasound technique. Material and methods: A retrospective cross-sectional observational study was carried out on oncosurgical patients referred to the nutrition consultation of the General University Hospital of Castellón over a four-year period. Malnutrition was diagnosed according to the GLIM criteria, muscle mass was assessed by ultrasound using a Mindray device, and skeletal muscle index (SMI) and appendicular skeletal muscle mass (PMI) were measured by computed tomography at the third lumbar vertebra (L3). Patients lacking a CT scan or with a CT scan performed more than one month after the ultrasound examination were excluded. Results: The study cohort comprised 43 patients (31 males), with a mean age of 64.7 ± 6.72 years, a mean BMI of 23.7 ± 4.31 kg/m², and a mortality rate of 25.6%. Most of the evaluations were conducted post-surgically (65.1%), with a notable prevalence of radical cystectomy and hepatic surgery. A total of 53 ultrasound evaluations were conducted, with an average area of 2.96 cm² [2.47-4.2] and adipose tissue of 0.55 cm [0.1-0.99] *. Additionally, computed tomography (CT) scans were performed to assess skeletal muscle mass (SMM) using the SMI/height method, yielding an average area of 38.4 cm² [31.6- 54.7)The median values for the variables were as follows: 272 [207-390] HU,PMI area of 4.31 m² [3.71-5.94] * and 86 [69-103] * HU density in PMI. All data were expressed as median and interquartile range. The Pearson correlation coefficients between US and SMI/height, SMI/height and PMI/height, and US and PMI/height were 0.70, 0.750, and 0.548, respectively. All these coefficients were statistically significant (p < 0.001). Following the established criteria for low muscle mass for SMI (1) and PMI (2), a ROC curve analysis was conducted on US, with a cutoff point for low muscle mass of 3.6 cm² , AUC 0.770 with 70% and specificity 100%.Respect PMI , the cut-off was 3.29 cm 2 and the area under the curve was 0.609, with a sensitivity of 42.55% and a specificity of 100%. Conclusions: The results of this study indicate that there is a significant correlation between SMI, PMI, and the area in cm² measured by US in the rectus femoris according to the protocol of García-Almeida et al. (3). The positive correlation between ultrasound and computed tomography (CT) imaging in our sample, which yielded comparable results to those reported by (4), suggests that ultrasonography may serve as a viable alternative to CT for the detection of low muscle mass. This study is the first to establish a cutoff point for ultrasonography in comparison to SMI and PMI. Further studies are required, utilising a semi-automatic method to circumvent measurement bias and encompassing a larger patient cohort, in order to detect cutoff points pre- and post-surgery for cystectomy and hepatic surgery, as well as cutoff points by sex.

BACKGROUND: Bilateral macronodular adrenocortical disease is often linked to autonomous cortisol secretion, but may also present with primary aldosteronism (PA). METHODS: This international (Europe, United States, Asia) retrospective cohort study included adults with radiological evidence of bilateral macronodular adrenocortical disease and biochemically confirmed PA. The primary endpoints was major adverse cardiovascular events (MACE); secondary end points included cardiometabolic comorbidities and surgical outcomes per PA surgical outcome criteria. RESULTS: Two hundred forty-nine patients from 41 centers in 12 countries were included (median age, 55 years; 62% male). Median hypertension duration at PA diagnosis was 9.9 years. Among 178 tested, 52% had cortisol cosecretion and 47% isolated PA. At baseline, 56% had metabolic comorbidities, and 16% had ≥1 MACE. Patients with MACE were older, more often male, had longer hypertension duration, and higher diabetes rates. Eighty-nine patients underwent adrenalectomy: 50 without MRA (mineralocorticoid receptor antagonists), 38 with MRA, and 1 with steroidogenesis inhibitors. One hundred twenty-four patients received continued MRA without adrenalectomy or steroidogenesis inhibitors. Adrenal venous sampling showed lateralized PA in 89% of surgical versus 19% of MRA-treated patients ( P <0.001). Over a median follow-up of 36 (MRA) and 18 months (surgery; P =0.2), MACE occurred in 8% and 6%, respectively ( P =1.0). Blood pressure and organ damage were similar, but more MRA-treated patients needed ≥3 antihypertensives (MRA: 48% versus adrenalectomy: 14%; P <0.001). Among operated patients, complete clinical and biochemical success was 26% and 71%, respectively. CONCLUSIONS: Bilateral macronodular adrenocortical disease with PA carries a high cardiometabolic burden. Early detection and precise subtyping are key to optimizing management and preventing target organ damage.

BACKGROUND: Left ventricular hypertrophy (LVH) is frequently identified in patients with primary aldosteronism; determinants of LVH regression after targeted treatment are debated. We assessed LVH prevalence before and after adrenalectomy or mineralocorticoid receptor antagonist (MRA) therapy, identified determinants of LVH regression, and evaluated the relationship between patients’ outcomes and cardiac remodeling. METHODS: We retrospectively analyzed an international cohort of patients with primary aldosteronism from 36 referral centers in Spain, Italy, and Germany. Echocardiographic recordings were included at baseline and after at least 1 year of targeted treatment. Regression models were applied to identify parameters associated with LVH regression and changes in left ventricular mass index. RESULTS: Among 1454 patients (mean age, 51 years; 58.7% men) with primary aldosteronism, baseline LVH prevalence was 49.4%. Aldosterone, blood pressure, male sex, number of antihypertensive medications, and diabetes were associated with LVH. Of 473 patients with follow-up echocardiography, 33.6% underwent adrenalectomy, 61.7% received MRA, and 4.7% were taking MRA postsurgery. After a median follow-up of 51 months, LVH regression was observed in 54.2% of patients (61.9% after adrenalectomy versus 48.6% with MRA treatment; P =0.043), and left ventricular mass index significantly decreased after both surgery and medical therapy. Higher pretreatment blood pressure and aldosterone levels were associated with a lower likelihood of LVH regression, regardless of treatment modality. Complete biochemical success was associated with greater left ventricular mass index reduction at follow-up. CONCLUSIONS: LVH regressed in over half the patients after targeted treatment, with left ventricular mass index decreasing after both adrenalectomy and MRA therapy. Baseline aldosterone levels were associated with LVH regression, independently of blood pressure load.