Image-Derived Enzymatic Adrenal Lateralisation of Primary Hyperaldosteronism (IDEAL)

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High blood pressure is a serious medical condition that, over time, causes damage to the heart and blood vessels. If left untreated, high blood pressure often leads to life threatening conditions, such as heart attack, stroke (bleeding in the brain), kidney disease and dementia (memory problems). For most people, lifestyle changes, and treatment with blood pressure lowering medication, return the blood pressure to healthy levels. However, sometimes high blood pressure cannot easily be controlled. This is particularly the case when there are other underlying conditions that raise the blood pressure. In about 1 out of 10 patients with high blood pressure (over half a million people in the UK), the condition is caused by too high production of a chemical, known as aldosterone, in the body. This condition (hyperaldosteronism) is very difficult to treat, and those affected have a particularly high risk of damaging the heart, kidneys and suffering from dementia. Patients with hyperaldosteronism will often need to take a number of medications (3-5 drugs) for the rest of their life, and are likely to have reduced life quality. However, for some of these patients (about one in four), removal of the gland (adrenal) that produces too much aldosterone can cure the high blood pressure, or at the very least, help reduce the need for blood pressure reducing medication. Unfortunately, very few patients with hyperaldosteronism (about 300 per year in the UK) are offered the chance to be treated with surgery as there are no practical methods to identify those who are likely to benefit. For surgery to be successful, it is of outmost importance to know which gland to remove - the one on the left or right side of the body. This can only be determined by taking blood samples from tiny blood vessels within the left and right adrenal glands, a procedure so difficult that it can only be performed by a handful of people in the UK. The goal of our research is to make it much easier to identify those patients with hyperaldosteronism who are likely to benefit from surgery, and to determine which gland (left or right) to remove, so that more people can be offered surgical treatment. We have developed a kind of 'chemical dye' for use with an advanced type of medical imaging, known as positron emission tomography (PET). If the 'dye' works as we hope, the PET scan will allow us to see how much aldosterone that each of the two adrenal glands (left and right) produce. This will make it possible to identify the patients who are most likely to benefit from surgery, and to determine which adrenal gland to remove. For this study, we will investigate if PET scanning with the 'dye' can be used to measure aldosterone production in adrenal glands in patients with hyperaldosteronism.