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What is the difference in unilateral and bilateral adrenal disease?

Once the diagnosis of primary hyperaldosteronism is confirmed, the next step is to figure out if the patient has unilateral disease (hyperactivity in one adrenal) or bilateral disease (hyperactivity in both adrenals). The first step is to perform radiographic imaging looking for an aldosterone producing adenoma or tumor. Computed tomography (CAT) scan or magnetic resonance imaging (MRI) of the abdomen are the best imaging tests to look at the adrenal glands. If there is an adrenal tumor in one gland, especially if it is between 1 and 2 cm in size, there is a high chance that it is an aldosterone producing adenoma. Another test that may be done to help distinguish between unilateral and bilateral disease is the postural stimulation test. In this test, the patient's aldosterone and renin levels in the blood are measured while the patient is lying down and then again when standing up. Patients with an aldosterone producing adenoma will not have any increase in aldosterone levels after standing up. Patients with bilateral hyperplasia will have an increase in aldosterone levels after standing up. However, these tests are not 100% accurate. For example, some patients with primary hyperaldosteronism may have an unrelated adrenal tumor that is not producing too much aldosterone. The best test to differentiate unilateral versus bilateral disease is the adrenal venous sampling. 

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