Background/Objectives: Mild autonomous cortisol secretion (MACS) can coexist with primary aldosteronism (PA). The purpose of our study was to evaluate whether (MACS) influences parameters analyzed during adrenal venous sampling (AVS) in patients with PA. Methods: Patients with PA from the SPAIN-ALDO Registry and the German Conn’s Registry with available 1 mg-dexamethasone suppression test (DST) and AVS were included. MACS was defined as a post-DST cortisol > 1.8 µg/dL in the absence of specific signs and symptoms of Cushing’s syndrome. Results: Two-hundred and twenty-five patients were included, 98 (43.6%) of whom had concomitant MACS. The mean age was 54 ± 10 years and 37.3% were women. AVS was performed by simultaneous catheterization of both adrenal veins and analysis of basal samples in 157 patients (69.8%), with both basal and post-ACTH samples in 15 patients (6.7%), and during continuous ACTH infusion in 53 patients (23.6%). AVS was considered technically unsuccessful in 40 cases (17.8%), suggesting unilateral secretion in 106 (47.1%) and bilateral secretion in 79 (35.1%). We did not find significant differences in the percentage of unilateral and bilateral results, cortisol, corrected aldosterone, or selectivity indices in the dominant and non-dominant veins, nor in the lateralization index or the contralateral suppression index between patients with and without MACS. They also had similar rates of surgical treatment and biochemical and clinical response. Conclusions: Although pathophysiological reasoning suggests that MACS could hinder AVS identification of unilateral forms of PA, our data suggest that such interference, if it exists, is of moderate clinical relevance.

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.