Participants
hypertension, adenoma
HYPERTENSION, ADENOMA
Participants were recruited through tertiary endocrinology clinics at SBH and CUH or complex hypertension clinics at SBH and GSTT. The criteria for inclusion consisted of patients aged 18 years or older with a probable or definite adenoma on CT or MRI scans of the adrenals (defined below) and meeting the Endocrinology Society criteria for diagnosis of PAThere was no minimum dimension used to classify an adenoma. For lesions above 10 mm, CT or MRI is able to outline the nodule and measure its CT density reliably as well as evaluate the loss of signal on out-of-phase images (MRI). For nodules below 10 mm, subjective visual criteria were applied and included: a focal increase in the caliber of an adrenal limb or body resulting in distortion and lobulation of the outer adrenal contour; and adrenal tissue adjacent to the nodule normal in both dimensions and contour.Exclusion criteria included individuals who: (1) were unlikely to proceed with surgery if recommended; (2) were contraindicated for spironolactone/eplerenone therapy use; (3) were unable to stop beta blockers or direct renin blockers; (4) were pregnant women or unable/unwilling to take secure contraceptive precautions while undergoing investigations; (5)were unable/unwilling to take the dexamethasone required to prepare for an MTO scan; (6) were unwilling/unable to have both MTO and AVS; or (7) had a condition or drug regimen that was considered a contraindication by the principal investigator.All eligible individuals gave written informed consent to participate in the study. Demographic data were also collected at the screening visit. This included age, sex, weight, height and ancestry. Ancestry was self-declared by individual participants using the list of ethnic groups for England and Wales, as defined by the Office for National Statistics