Summary English

A unilateral aldosterone-producing adenoma (APA) and bilateral aldosterone secretion due to hyperplasia (BAH) are the most frequent causes of primary aldosteronism (PA)-related hypertension. After biochemical confirmation of PA, the diagnostic workup requires accurate subtyping since appropriate treatment is adrenalectomy for an APA and lifelong treatment with anti-mineralocorticoid drugs for BAH. The current adrenal venous sampling (AVS) procedure to differentiate both conditions deserves improvement since it is a laborious, time consuming, costly and patient unfriendly procedure fraught with interpretative error related to diagnostic inaccuracy of aldosterone:cortisol ratios. The first purpose of this study is to test whether a novel adrenochrome-based colourimetric bedside test might reduce AVS procedure time. A second aim is to establish whether aldosterone:metanephrine ratios might provide a more accurate test to diagnose excess aldosterone secretion compared to standard aldosterone:cortisol ratios. We will also examine steroidomic profiles and other biomarkers in adrenal venous plasma in relation to intra-tumoural expression of related factors to establish whether APA and BAH are associated with distinctive diagnostic “signatures”. Our preliminary data indicate that the proposed novel procedures are likely to considerably improve diagnostic characterization of APA and BAH, thereby offering potential for improved therapy of this important cause of hypertension.