Improving diagnosis in primary aldosteronism using HISTALDO and nodule size metrics
Authors' conclusion
HISTALDO may over-report non-classical histology. Adding the B2 ratio improves diagnostic accuracy, distinguishing APA with background zona glomerulosa activity from true multinodular disease, facilitating patient management and follow-up.
Study context
- Population
- Patients with unilateral primary aldosteronism (PA) undergoing adrenalectomy (2017–2022), Karolinska University Hospital
- Participants
- 75 patients
- Exposure
- HISTALDO vs HISTALDO with B2 ratio classification
- Outcome
- Histological classification (classical vs non-classical)
Methodological detailssingle-centre, standardized tissue sampling
- Single-centre
- Standardized tissue sampling
Main finding
As reported in the abstract
- HISTALDO: classical cases
- 20
- HISTALDO: non-classical cases
- 55
- Median B2 ratio (non-classical)
- 9
- Non-classical cases reclassified with B2 ratio cut-off ≥8.1
- 29/55
- HISTALDO B2R: classical cases
- 49
- HISTALDO B2R: non-classical cases
- 26
Observational data: associations, not effects.
Further findings
B2 ratio and complete clinical response (PASO criteria) · postoperative
- Higher B2 ratios correlated with complete clinical response
- P = 0.0038
- B2 ratio as independent predictor of complete response (trend), OR
- 1.07, P = .058
B2 ratio and number of antihypertensive medications · postoperative
- Higher B2 ratios correlated with fewer antihypertensive medications
- R = −0.4, P = .0022
Original publication
Improving diagnosis in primary aldosteronism using HISTALDO and nodule size metrics. Eur J Endocrinol. Published 29 July 2025. doi:10.
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