The SPARTACUS Trial: Controversies and Unresolved Issues

Adrenal vein sampling (AVS) is considered the gold standard for the di erential diagnosis in patients with primary aldoster- onism (PA). The distinction between unilateral and bilateral disease dictates the targeted therapeutic approach with sur- gery for aldosterone producing adenomas and medical thera- py for patients with bilateral hyperplasia. Thereby, this diag- nostic step is crucial in clinical care. As AVS is an invasive, not well standardized procedure that is restricted to few specialized centers, several attempts have been made to simplify diagnos- tic algorithms. In this clinical scenario, the recently published SPARTACUS trial aimed at answering the question whether AVS in fact is superior for di erential diagnosis in comparison to imaging of the adrenal glands. In this multicenter study, pa- tients were randomized to be treated according to AVS results or based on abdominal imaging only. Clinical outcome in both patient groups after one year was reported as not di erent. While the study results found broad interest, it also stirred con- siderable controversies. This review provides an overview on the di erent views regarding the outline of the SPARTACUS trial and the interpretation of its results.