Adrenal Venous Sampling Research Articles

Clinical value of 68Ga-pentixafor PET/CT in patients with primary aldosteronism and bilateral lesions: preliminary results of a single-centre study

BackgroundSubtype diagnosis of primary aldosteronism (PA) is used to determine treatment, and the potential utility of 68Ga-pentixafor PET/CT for investigation of PA has long been recognized. The study aimed to evaluate the clinical value of 68Ga-pentixafor PET/CT in the diagnosis and prognosis of patients with bilateral lesions identified by CT.MethodsIn total, 25 patients with PA and bilateral lesions on CT were retrospectively evaluated. All patients underwent 68Ga-Pentixafor PET/CT and adrenal vein sampling. The analysis focused on establishing the relationship between bilateral adrenal lesions SUVmax and the ratio of bilateral adrenal lesions SUVmax (CON) and clinical diagnosis, treatment outcomes, and KCNJ5 gene status.ResultsThe concordance rate between 68Ga-Pentixafor PET/CT and adrenal venous sampling was 65.2% (15/23). The lateralization results of 68Ga-pentixafor PET/CT supported the clinical decisions of 20 patients with PA, 90% of whom showed effectiveness in treatment. The SUVmax on the dominant side of the surgically treated patients was higher than that of patients treated with drugs. The SUVmax of the KCNJ5 mutant group was higher than that of the KCNJ5 wild group, and 68Ga-Pentixafor uptake was correlated with KCNJ5 gene status.Conclusions68Ga-Pentixafor PET/CT proves beneficial for patients with PA with bilateral lesions on CT. The treatment is generally effective based on the results of PET lateralization. Simultaneously, a certain relationship exists between 68Ga-Pentixafor PET/CT and KCNJ5 gene status, warranting further analysis.

Evaluation of adrenal vein anatomy by adrenal venous sampling in patients with primary aldosteronism in Chinese.

Accurate cannulation of the adrenal vein is challenging during adrenal venous sampling (AVS) because of the variations in adrenal vein anatomy. This study aimed to investigate the adrenal venous morphology in Chinese and improve the success rate of AVS. A total of 221 participants with primary aldosteronism (PA) who underwent AVS were enrolled. Compare the morphology among subgroups divided according to sex, body mass index (BMI), and with or without adenoma. The success rate of right, left, and bilateral AVS was 98.60%, 97.20%, and 96.85%, respectively. The triangular pattern was the most common (39.37%) on the right side, while the glandlike pattern (70.14%) on the left. The proportion of adrenal venous morphology varies among patients with different sexes (χ2=21.335, P<.001), BMI (χ2=10.642 P=.031), and with or without adenoma (χ2=10.637, P=.031) on the right side, and the male, obese and adenoma group showed a higher proportion of glandlike pattern than triangular pattern. If only dependent on computed tomography, 9.05% of patients incorrectly diagnose the dominant side, 14.48% of patients would have inappropriate surgery meanwhile 25.34% of patients would miss the surgical opportunity. In conclusion, the most common types of right and left adrenal venous morphology were triangular pattern and glandlike pattern, respectively. Sex, BMI, and the presence of adenoma affected right adrenal venous morphology. Adequate knowledge of the adrenal venous morphology is critical for improving the success rate of AVS and making an appropriate treatment for PA.

Hiperaldosteronismo primario

Primary hyperaldosteronism (PHA) is the most frequent cause of secondary hypertension (HT). Furthermore, it is associated with greater cardiometabolic and mortality risk than the observed in patients with essential HT. It is recommended to screen for PHA by determining the aldosterone-to-renin ratio in patients with severe and/or resistant HT, HT with hypokalemia, HT and adrenal incidentaloma, HT and a first-degree family history of PHA, and in HT associated with atrial fibrillation that cannot be explained by other causes. If a pathological aldosterone-to-renin ratio is confirmed, dynamic tests should be performed to establish a confirmatory diagnosis; these are usually a saline infusion test or captopril challenge test. These tests can be omitted in patients with overt PHA (plasma aldosterone greater than 20 ng/dl, suppressed renin, and hypokalemia). The last step in the diagnosis is the localization study, being the computed tomography (CT) scan of the adrenal glands the initial test of choice. Nevertheless, in most patients in whom adrenal surgery is considered, adrenal vein sampling (AVS) will be necessary to establish PHA laterality. AVS is not considered necessary in cases of suspected aldosterone-producing adrenocortical carcinoma and/or PHA in patients younger than 35 years with a clear unilateral lesion on a CT/magnetic resonance imaging (MRI) test. The treatment of PHA depends on the results of the localization study: the treatment of choice is a unilateral adrenalectomy in unilateral forms and mineralocorticoid receptor antagonists in bilateral forms.

#357 Sex differences in the aldosterone-renin system must be taken into account during screening for primary aldosteronism

Abstract Background and Aims Primary aldosteronism (PA) is one of the most frequent causes of secondary hypertension. Patients with PA are at higher risk for cardiovascular and renal complications than those with essential hypertension. Screening for PA is rarely considered in the assessment of a hypertensive patient, in part because of difficulties in the diagnostic process. Nevertheless, identification of PA is crucial to guide patients towards optimal management, either by mineralocorticoid receptor blockade or by unilateral adrenalectomy, with the latter offering potential cure for patients with aldosterone-producing adenomas (APAs). Numerous studies show inadequate diagnostic accuracy of the aldosterone:renin ratio (ARR) for screening for PA, particularly in females, who have higher ARR variability and lower renin compared to males. Women have a higher risk of false-positive screening results leading to unnecessary confirmatory tests. Use of oral contraception (OC) or hormone replacement therapy (HRT) may also confound the ARR. The aim of this study was to develop improved screening tools for PA, including adjustments for sex-specific differences. Method PROSALDO is a multicenter prospective cohort study designed to test new diagnostic procedures for patients with suspected PA. Medication that interfere with the renin-angiotensin-aldosterone system are withdrawn before laboratory measurements. For screening, the routine ARR is calculated along with additional probability scores based on a peripheral venous steroid hormone profile (PVSP). The latter allows for identification of potentially false-negative ARR results. After a positive screening result of the ARR and/or a high probability score based on the PVSP, PA is confirmed or excluded with a saline infusion test (SIT). PA confirmation is followed by adrenal venous sampling (AVS) to identify patients with unilateral PA. We compared aldosterone, renin and ARR levels between females and males with and without PA. Renin- and sex dependent formulas for aldosterone screening cut-offs were derived from the study population. Logistic regression and the corresponding receiver operating characteristic (ROC) curves were used to determine and compare diagnostic accuracies. Results PA was confirmed in 159 (24.5%) of 649 (328 (50.5%) females and 321 (49.5%) males). Lateralization was shown in 58 out of 117 patients who underwent AVS. In hypertensive patients without PA, ARR was higher in females vs. males (26.4 vs. 11.7 pmol/mU, P &amp;lt; 0.0001), mainly due to a lower renin (9.2 vs. 16.2 mU/L, P &amp;lt; 0.0001). Furthermore, ARRs in patients with vs. without PA showed more overlap in females compared to males. Areas under ROC curves (AUROCs) for the ARR were 0.857 (CI 95%: 0.797-0.902) vs. 0.912 (CI 95%: 0.876-0.938) for females and males respectively. Using liquid chromatography mass spectrometry measurements (LC-MS/MS) of aldosterone, an ARR cut-off of 21.75 pmol/L yielded a sensitivity of 93% with only 45% specificity in females, while for males, a specificity of 66% was obtained for a sensitivity of 97.7%. This meant for females having a higher risk of false-positive screening results (OR 2.36 (CI 95%: 1.65-3.41)), even after excluding patients on OC or HRT (OR 2.17 (CI 95%: 1.5-3.17)). We derived a renin- and sex-dependent formula for the calculation of aldosterone cut-offs, which improved diagnostic accuracy for both males and females (ΔAUROC = 0.05 and 0.045, P &amp;lt; 0.0001 and 0.02 respectively): for a diagnostic sensitivity of 94-95%, specificity was improved to 61% in females and 82% in males. Conclusion Lower renin in females without PA leads to higher ARRs and thus a higher risk of false-positive screening results. Higher overlap of the ARR between females with and without PA compared to their male counterparts weakens utility of the ARR for discrimination of patients with and without PA. Sex- and renin-specific aldosterone cut-offs for screening for PA offer improved diagnostic accuracy. Diagnostic accuracy remains however superior in males, which highlights the need for further optimization of diagnostic procedures specifically in women.

Challenges in Diagnosing and Managing the Spectrum of Primary Aldosteronism.

Primary aldosteronism, characterized by the dysregulated production of aldosterone from 1 or both adrenal glands, is the most common endocrine cause of hypertension. It confers a high risk of cardiovascular, renal, and metabolic complications that can be ameliorated with targeted medical therapy or surgery. Diagnosis can be achieved with a positive screening test (elevated aldosterone to renin ratio) followed by confirmatory testing (saline, captopril, fludrocortisone, or oral salt challenges) and subtyping (adrenal imaging and adrenal vein sampling). However, the diagnostic pathway may be complicated by interfering medications, intraindividual variations, and concurrent autonomous cortisol secretion. Furthermore, once diagnosed, careful follow-up is needed to ensure that treatment targets are reached and adverse effects, or even recurrence, are promptly addressed. These challenges will be illustrated in a series of case studies drawn from our endocrine hypertension clinic. We will offer guidance on strategies to facilitate an accurate and timely diagnosis of primary aldosteronism together with a discussion of treatment targets which should be achieved for optimal patient outcomes.

Temporal trends in clinical features of patients with primary aldosteronism over 20 years

Primary aldosteronism (PA) accounts for approximately 5-10% of hypertension cases. Over the past 20 years, the reported incidence of PA has increased due to widespread screening for secondary hypertension and imaging studies. We aimed to evaluate the temporal trends in the clinical characteristics and subtypes of PA. A total of 1064 patients with PA in two tertiary hospitals between 2000 and 2021 were categorized into three groups according to the year of diagnosis: 2000–2009, 2010–2015, and 2016–2021. The clinical characteristics of the patients over the three time periods were compared using a trend analysis. The age at diagnosis and sex of patients with PA did not change over 20 years. The proportion of patients with bilateral hyperaldosteronism (BHA) increased (11%, 25%, and 40%, P for trend <0.001). The proportion of hypokalemia (87%, 61%, and 40%) and plasma aldosterone concentration (36.0, 30.8, and 26.6 ng/dL) decreased (all P for trend <0.001). There was a trend toward an increased proportion of incidentally detected patients compared to clinically symptomatic patients (36%, 55%, and 61%, P for trend <0.001). The concordance rate of imaging and adrenal venous sampling results decreased (91%, 70%, and 57% P for trend <0.001). However, the proportion of patients with resistant hypertension and comorbidities did not differ. In conclusion, among patients with PA, patients with BHA and incidental detection have increased over 20 years, and more patients are likely to present with milder clinical symptoms and biochemical profiles.

Selective venous sampling for secondary hypertension.

Selective venous sampling (SVS), an invasive radiographic procedure that depends on contrast media, holds a unique role in diagnosing and guiding the treatment of certain types of secondary hypertension, particularly in patients who may be candidates for curative surgery. The adrenal venous sampling (AVS), in particular, is established as the gold standard for localizing and subtyping primary aldosteronism (PA). Throughout decades of clinical practice, AVS could be applied not only to PA but also to other endocrine diseases, such as adrenal Cushing syndrome (ACS) and Pheochromocytomas (PCCs). Notably, the application of AVS in ACS and PCCs remains less recognized compared to PA, with the low success rate of catheterization, the controversy of results interpretation, and the absence of a standardized protocol. Additionally, the AVS procedure necessitates enhancements to boost its success rate, with several helpful but imperfect methods emerging, yet continued exploration remains essential. We also observed renal venous sampling (RVS), an operation akin to AVS in principle, serves as an effective means of diagnosing renin-dependent hypertension, aiding in the identification of precise sources of renin excess and helping the selection of surgical candidates with renin angiotensin aldosterone system (RAAS) abnormal activation. Nonetheless, further basic and clinical research is needed. Selective venous sampling (SVS) can be used in identifying cases of secondary hypertension that are curable by surgical intervention. Adrenal venous sampling (AVS) and aldosterone measurement for classificatory diagnosis of primary aldosteronism (PA) are established worldwide. While its primary application is for PA, AVS also holds the potential for diagnosing other endocrine disorders, including adrenal Cushing's syndrome (ACS) and pheochromocytomas (PCCs) through the measurements of cortisol and catecholamine respectively. In addition, renal venous sampling and renin measurement can help to diagnose renovascular hypertension and reninoma.

Assessing Lateralization Index of Adrenal Venous Sampling for Surgical Indication in Primary Aldosteronism.

Clinical practice guidelines recommend the Lateralization Index (LI) as the standard for determining surgical eligibility in primary aldosteronism (PA). Our goal was to identify the optimal LI cut-offs in adrenal venous sampling (AVS) for diagnosing PA that is amenable to surgical cure. We conducted a retrospective international cohort study across 16 institutions in 11 countries, including 1,550 patients with PA who underwent AVS, with and/or without ACTH stimulation. The establishment of optimal cut-offs was informed by a survey of 82 PA patients in Japan, aimed at determining the LI cut-off aligned with patient expectations for a surgical cure rate. The survey revealed that a median cure rate expectation of 80% would motivate PA patients towards undergoing adrenalectomy. The optimal LI cut-offs achieving an adjusted positive predictive value (PPV) of 80% were identified as 3.8 for unstimulated AVS and 3.4 for ACTH-stimulated AVS. Furthermore, a contralateral ratio of less than 0.4 and the detection of an adrenal nodule on CT imaging were identified as independent predictors of surgically curable PA. Incorporating these factors with the optimal LI cut-offs, the adjusted PPV increased to 96.6% for unstimulated AVS and 89.6% for ACTH-stimulated AVS. No clear differences in predictive ability between unstimulated and ACTH-stimulated LI were found. The present study clarified the optimal LI cut-offs for without and with ACTH stimulation. The presence of contralateral suppression and adrenal nodule on CT imaging seems to provide additional available information besides LI for surgical indication.

Antecubital vein combined with femoral vein pathway could shorten the learning curve of simultaneous bilateral adrenal vein sampling.

During our previous bilateral adrenal vein sampling (AVS) procedure, the authors observed that accessing the left adrenal vein through the antecubital vein was more feasible than the conventional femoral vein. Meanwhile, the femoral vein pathway facilitated access to the right adrenal vein than the antecubital vein pathway. Therefore, the authors hypothesized that simultaneous bilateral AVS via the antecubital combined with the femoral vein pathway could improve the success rate. A total of 94 cases of AVS via the antecubital combined with the femoral vein pathway were performed, while the remaining 20 cases employed the antecubital vein pathway at our center between August 2020 and April 2023. Furthermore, a meta-analysis was conducted in this study using 15 selected articles to determine the success rate of AVS in each center and pathway. The success rate of ACTH-stimulated simultaneous bilateral AVS via the antecubital vein combined with the femoral vein pathway was 92.85% (P=.503) on the right and 95.00% (P<.001) on the left. In the antecubital vein pathway, the success rates were only 25.00% (P<.001) on the right side and 80.00% (P=.289) on the left side. The results of meta-analysis demonstrated a success rate of 78.16% on the right and 94.98% on the left for ACTH-stimulated AVS via the femoral vein pathway. Based on our center's experience, simultaneous bilateral adrenal vein sampling via the combined pathway could improve the success rate of AVS in the short term and shorten the learning curve.

Pre-procedural and intra-procedural computerized tomography: providing a roadmap for successful adrenal venous sampling procedures

Background and purposeAdrenal venous sampling (AVS) is used for the diagnosis of primary hyperaldosteronism. Technical difficulties with right adrenal vein (RAV) catheterization can lead to erroneous results. Our purpose was to delineate the location of the RAV on pre-procedural CT imaging in relation to the location identified during AVS and to report on the impact of successful RAV cannulation with and without the use of intra-procedural CT scanning.MethodsRetrospective case series including patients who underwent AVS from October 2000 to September 2022. Clinical and laboratory values were abstracted from the electronic medical record. Successful cannulation of the RAV was defined as a selectivity index > 3.Results110 patients underwent 124 AVS procedures. Pre-AVS CT imaging was available for 118 AVS procedures. The RAV was identified in 61 (51.7%) CT datasets. Biochemical confirmation of successful RAV cannulation occurred in 98 (79.0%) of 124 AVS procedures. There were 52 (85.2%) procedures in which the RAV was identified on pre-AVS CT and there was biochemical confirmation of successful RAV sampling. Among these 52 procedures, the RAV was localized during AVS at the same anatomic level or within 1 vertebral body level cranial to the level identified on pre-AVS CT in 98.1% of cases. The rate of successful RAV cannulation was higher in patients who underwent intra-procedural CT (93.8% versus 63.9%), P < 0.01.ConclusionsPre-AVS and intra-procedural CT images provide an invaluable roadmap that resulted in a higher rate of accurate identification of the RAV and successful AVS procedures; in particular, search for the RAV orifice during AVS can be limited to 1 vertebral body cranial to the level identified on pre-AVS CT imaging and successful cannulation can be confidently verified with intra-procedural CT.

Adrenal venous sampling in patients with bilateral adrenal lesions and ACTH-independent cushing's sydrome

Adrenal venous sampling in patients with bilateral adrenal lesions and ACTH-independent cushing's sydrome

Use of selective adrenal and ovarian venous sampling in postmenopausal women with severe hyperandrogenism: Report of 3 cases

Use of selective adrenal and ovarian venous sampling in postmenopausal women with severe hyperandrogenism: Report of 3 cases

Clinical significance of adrenal venous sampling in primary hyperaldosteronism: a case report

Clinical significance of adrenal venous sampling in primary hyperaldosteronism: a case report

Contralateral suppression in adrenal venous sampling predicts clinical and biochemical outcome in primary aldosteronism

Contralateral suppression in adrenal venous sampling predicts clinical and biochemical outcome in primary aldosteronism

Improved selectivity of adrenal venous sampling with the use of alternative steroids to cortisol

Improved selectivity of adrenal venous sampling with the use of alternative steroids to cortisol

Peripheral cortisol concentration during adrenal vein sampling for primary aldosteronism

Peripheral cortisol concentration during adrenal vein sampling for primary aldosteronism

Respiratory Displacement of the Right Adrenal Vein: Comparison of Inspiratory and Expiratory Computed Tomography With Catheter Venography.

The aim of the study is to reveal the respiratory displacement of the right adrenal vein (RAV) to predict the exact location of the RAV during adrenal venous sampling (AVS). Computed tomography (CT) scans obtained 45 seconds (breath-hold at inhalation) and 70 seconds (breath-hold at exhalation) after contrast material injection were compared to venograms of the RAV of patients with primary aldosteronism who underwent AVS between January 2016 and December 2020. The craniocaudal distance between the center of the Th11/12 disc and the RAV orifice was measured; the craniocaudal location of the RAV orifice was also specified relative to vertebral bodies and intervertebral discs on inspiratory phase CT (In-CT), expiratory phase CT (Ex-CT), and catheter venography. The transverse and vertical angles of the RAV and the position of the RAV orifice on the inferior vena cava (IVC) circumference were measured on In-CT and Ex-CT. In total, 51 patients (30 males, 21 females; mean age, 54.9 ± 11.1 years) were included. Craniocaudal distances between the center of the Th11/12 disc and RAV orifice were significantly different among the following 3 acquisitions: catheter venography versus In-CT (15.2 ± 8.4 mm); venography versus Ex-CT (5.6 ± 4.1 mm); and In-CT versus Ex-CT (19.6 ± 8.0 mm) (all, P < 0.001). The craniocaudal location of the RAV orifice on venography was significantly closer to that on Ex-CT than on In-CT (P < 0.001); measurements using venograms compared with In-CT and Ex-CT scans were within 1 level difference in 18 (35.3%) and 47 (92.2%) patients, respectively (P < 0.001). The vertical angle of the RAV was significantly more likely to be smaller on In-CT than on Ex-CT (P < 0.001). RAV locations and angles change with respiratory motion. It is crucial to consider the respiratory phase of CT because it can enable a more accurate prediction of the location of the RAV during AVS.

FEASIBILITY OF SUBTYPING OF PRIMARY ALDOSTERONISM BY ADRENAL VEIN SAMPLING DURING MINERALOCORTICOID RECEPTOR ANTAGONIST TREATMENT

Objective: Current guidelines and consensus documents recommend withdrawal of mineralocorticoid receptor antagonists (MRA) before primary aldosteronism (PA) subtyping by adrenal venous sampling (AVS), but this practice can cause severe hypokalemia and/or uncontrolled high blood pressure (BP) values in PA patients. The aim of the study was to investigate if identification of unilateral PA (uPA) by means of AVS is feasible in patients on MRA treatment. Design and method: We compared the rate of uPA identification between patients with and without MRA treatment in two large datasets of patients who were submitted to AVS from 2000 to 2023 without renin-angiotensin system blockers and beta-blockers. In sensitivity analyses, the between-groups differences of lateralization index (LI) values after propensity score matching and the rate of uPA identification in subgroups with undetectable (&lt; 2 mUI/L), suppressed (&lt; 8.2 mUI/L) and unsuppressed (&gt; 8.2 mUI/L), direct renin concentration (DRC) levels were also evaluated. Results: A minority of the PA patients (n = 61, 7.3%) underwent AVS on MRA treatment, while the majority were off MRA (n = 779, 92.7%). Compared to non-MRA patients, those with MRA showed a higher daily drug dose (2.25 vs 1.5, p = 0.001), a higher rate of adrenal nodules at imaging (82 vs 67, p = 0.022) and of adrenalectomy (72 vs 54%, p = 0.01). The AUROC of lateralization index (LI) showed no significant differences between groups, either under unstimulated conditions (0.960 vs 0.937, p = 0.590) or after cosyntropin (0.923 vs 0.917, p = 0.938). Sensitivity analyses confirmed these results after propensity score matching in several adjusted models and in patients with undetectable, suppressed or unsuppressed renin levels. Conclusions: MRAs, at doses that controlled blood pressure and potassium levels in PA patients, did not preclude the identification of uPA at AVS.

Adrenal Vein Sampling: Tips and Tricks.

Adrenal vein sampling (AVS) is the standard method for distinguishing unilateral from bilateral sources of autonomous aldosterone production in patients with primary aldosteronism. This procedure has been performed at limited specialized centers due to its technical complexity. With recent advances in imaging technology and knowledge of adrenal vein anatomy in parallel with the development of adjunctive techniques, AVS has become easier to perform, even at nonspecialized centers. Although rare, anatomic variants of the adrenal veins can cause sampling failure or misinterpretation of the sampling results. The inferior accessory hepatic vein and the inferior emissary vein are useful anatomic landmarks for right adrenal vein cannulation, which is the most difficult and crucial step in AVS. Meticulous assessment of adrenal vein anatomy on multidetector CT images and the use of a catheter suitable for the anatomy are crucial for adrenal vein cannulation. Adjunctive techniques such as intraprocedural cortisol assay, cone-beam CT, and coaxial guidewire-catheter techniques are useful tools to confirm right adrenal vein cannulation or to troubleshoot difficult blood sampling. Interventional radiologists should be involved in interpreting the sampling results because technical factors may affect the results. In rare instances, bilateral adrenal suppression, in which aldosterone-to-cortisol ratios of both adrenal glands are lower than that of the inferior vena cava, can be encountered. Repeat sampling may be necessary in this situation. Collaboration with endocrinology and laboratory medicine services is of great importance to optimize the quality of the samples and for smooth and successful operation. ©RSNA, 2024 Test Your Knowledge questions for this article are available in the supplemental material.

EVALUATION OF THYROID FUNCTION AND THYROID DISEASES IN PATIENTS WITH PRIMARY ALDOSTERONISM

Objective: To explored the thyroid function and prevalence of thyroid diseases in primary aldosteronism (PA) and PA subtypes. Design and method: Patients with PA and Essential hypertension (EH) in our hypertension center between August 2011 to June 2022 were enrolled in this observational study. All PA patients underwent adrenal venous sampling (AVS), thus receiving the most accurate subtype diagnosis available. The differences of thyroid function and the prevalence of thyroid diseases between PA and EH patients were analyzed. Results: 7161 participants were included in the study with a mean age of 48.20±8.83 years and a mean BMI of 26.52±3.45 kg/m2. Two groups: PA patients showed lower FT4, FT3, TT4, TT3, positive TPOAb and higher prevalence of thyroid nodules (22.5%) than EH patients. PA was significantly associated with thyroid nodules (OR: 1.245, 95%CI: 1.052-1.473, P= 0.011). Three groups: statistical differences in FT4, FT3, TT4, TT3, and positive TPOAb levels were found in APA, IHA and EH. Thyroid nodules are most prevalent in APA (26.00%), followed by IHA (20.80%) and EH (17.80%). APA showed a significant association with thyroid nodules (OR: 1.345, 95%CI: 1.015-1.781, P=0.039). Additionally, it was found that FT4, FT3, TT4, and TT3 were negatively correlated with the PAC levels in patients. The stratification analysis showed that the prevalence of thyroid nodules was higher in subjects with PAC levels great than or equal to 12ng/dL. Conclusions: Compared to EH groups, PA patients had lower thyroid function and higher prevalence of thyroid nodules.