When we talk about high blood pressure, in the vast majority of cases we think ofessential hypertensioni.e. without a specific cause. But we must not forget that sometimes, albeit rarely, the increase in blood pressure can be linked to the presence of specific lesions capable of altering the systolic and diastolic levels. One of these situations is represented by the presence of nodules of the adrenal glands. If the standard examination to recognize excess production of aldosterone (responsible for the increase in pressure) is the catheterization of the adrenal veins, which can only be done in highly specialized centers and does not always allow to arrive at the diagnosis, now an English research shows that a CT scan (although it would be more correct to speak of CT ) of ten minutes can get to identify small lesions. How? Thanks to a specific tracer that thickens in the nodule, coloring it. Thus, in the future, it will be easier to identify these adrenal alterations that lead to hypertension often resistant to drugs. A study conducted by experts from the Queen Mary University of London together with scholars from the Barts Hospital and Cambridge University Hospital, coordinated by Morris Brown e William DrakePublished on Nature Medicine.
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Why you need to study the adrenals
In most people with high blood pressure, the cause is unknown. The only possible therapy therefore aims to lower the high blood pressure values, with treatments tailored on a case-by-case basis, in order to reduce the cardiovascular risk. But be careful: the same scholars of Queen Mary University have revealed in recent years that in at least five out of a hundred people with hypertension there is a sort of genetic “stigma” that leads the adrenal glands to produce an abnormal amount of aldosterone. This hormone leads to retention of sodium, with an increase in blood pressure. For this reason, those who have excess aldosterone in their blood tend not to respond to treatments with the available drugs and to maintain abnormally high systolic and diastolic levels, with a consequent increasing risk of heart attack and stroke. “The origin of this excessive endocrine activity could be in a unilateral nodule of the adrenal glands, not visible with ultrasound or traditional CT and, therefore, diagnosable only thanks to a complex procedure such as selective catheterization of the adrenal veins – he explains Claudio Ferri, director of the Chair of Internal Medicine of the University of L’Aquila”.
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A “spy” locates the nodules
The British research examined 128 subjects with hypertension linked to excess aldosterone. Thanks to the targeted CT scan, it was seen that in about two thirds of the cases the hypertension (often resistant to treatment) was linked to the presence of a completely benign nodule, which was found in one of the two structures that are found as real own “hats” over the kidney. And above all, it was seen that this lesion could be removed without problems. How did the pathological nodule come to be discovered? Thanks to a radioactive dye capable of binding only to the lesion that produces excess aldosterone. The compound is called methomidate. The tomography only lasts 10 minutes and associating it (in the case of a “hot” nodule) with a test for the search for hormones in the urine can allow to identify the patients who best respond to the drugs.
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Towards a tailored therapy
“The study shows that the CT scan done with a special tracer could make the identification of the aldosterone-secreting adrenal nodule more specific, quick and simple and thus favor a more streamlined diagnosis – reports Ferri – but above all avoid the missed diagnosis of a resolvable arterial hypertension with the appropriate surgical therapy for years, which can also be performed laparoscopically”. The research examined subjects who underwent selective adrenal vein catheterization or CT with methomidate, who were then “crossed”, whereby all underwent selective adrenal vein catheterization first and then both diagnostic strategies. “The results of the study are very interesting: they demonstrate the safety of the non-invasive procedure with the CT scan and its accuracy in replacing a complex procedure, difficult to perform except in expert hands and, moreover, notoriously not even executable in different hospitals – concludes the expert”.
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