We recruited 58 eligible consecutive patients with PA who were referred to endocrinology units in Helsinki, Tampere, and Turku University Hospitals between February 2012 and December 2015. Patients fulfilling the criteria for confirmed PA according to the 2008 Endocrine Society guidelines (18 (link)) who were willing and eligible for possible adrenalectomy were included (Fig. 1). Inclusion criteria were age between 20 and 70 years, good general health enabling possible adrenalectomy, and a BMI of less than 35 kg/m2. The exclusion criteria are presented in the Supplementary material (see section on supplementary materials given at the end of this article). A prespecified post hoc, blinded adrenal CT analysis was performed by a single experienced specialist in abdominal radiology (E.L.).
All subjects underwent AVS and 11C-MTO-PET imaging in random order. Subjects with lateralization of aldosterone secretion in AVS were allocated to adrenal surgery (adrenalectomy group). In case of unsuccessful AVS, concordant findings suggesting single adrenal adenoma on 11C-MTO-PET and adrenal CT justified adrenal surgery. The postoperative outcome was evaluated about 3 months after adrenalectomy. For those treated with medical therapy (medical therapy group), medicine and blood pressure data were collected after lateralization studies for comparison. We applied retrospectively the PASO consensus criteria for a surgical cure (19 (link)). The detailed blood pressure, daily defined dose (DDD) of antihypertensive medication, and biochemical cut points are described in the PASO study (19 (link)).
All subjects provided written informed consent. The study protocol was approved by the ethics committee of Turku University Hospital and the study was registered in the ClinicalTrials.gov database (NCT01567111). The study was undertaken in accordance with the Declaration of Helsinki. Patients received written information describing AVS and 11C-MTO-PET procedures, including benefits and predictable complications.