Aldosterone synthase expression vs cross-sectional imaging in lateralized primary aldosteronism
Authors' conclusion
Even in patients with lateralized PA, IHC mapping of aldosterone sources corresponded with imaging findings in approximately half of the cases.
Study context
- Population
- Patients with primary aldosteronism (PA) who underwent unilateral adrenalectomy, 2012–2024; age 52.6 ± 11.8 years, 68.8% men
- Participants
- 173 patients
- Exposure
- Cross-sectional imaging vs CYP11B2 immunohistochemistry (IHC) of adrenal tissue
- Outcome
- IHC–imaging concordance
Methodological detailssingle referral-center, blinded imaging interpretation
- Single referral-center
- Blinded imaging interpretation
Main finding
As reported in the abstract
- Single corresponding aldosterone-producing adenoma (APA) or APN on both IHC and imaging
- 53/173 (31%)
- Concordant APA/APN with additional adrenal thickening
- 38/173 (22%)
- Discrepant IHC-imaging findings
- 82 (47.4%)
- Discrepant: ipsilateral nonfunctional adenoma on imaging
- 21
- Discrepant: bilateral nodules on imaging
- 29
- Discrepant: contralateral nodule(s) on imaging
- 6
- Discrepant: normal adrenals on imaging but discrete CYP11B2-positive foci on IHC
- 2
- Discrepant: unilateral adrenal hyperplasia on imaging but discrete CYP11B2-positive foci on IHC
- 4
- Discrepant: corresponding APA/APN with additional CYP11B2-positive area(s)
- 20
Observational data: associations, not effects.
Further findings
CYP11B2 IHC findings
- Single APA
- 87 (50.3%)
- Single APN
- 38 (22.0%)
- Multiple CYP11B2-positive foci
- 45 (26.0%)
- No CYP11B2-positive lesions
- 3
Characteristics by concordance
- Concordant patients had the highest proportion of women and KCNJ5 mutations; CACNA1D mutations most frequent in discordant group
Original publication
Aldosterone synthase expression vs cross-sectional imaging in lateralized primary aldosteronism. J Clin Endocrinol Metab. Published 6 May 2026. doi:10.
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