A Multi-institutional Comparison of Adrenal Venous Sampling in Patients with Primary Aldosteronism: Caution Advised if Successful Bilateral Adrenal Vein Sampling is Not Achieved

Adrenal venous sampling (AVS) is the gold standard test to differentiate the unilateral from the bilateral form in patients with primary aldosteronism (PA) although it may be a difficult procedure, especially the successful cannulation of the right adrenal vein. In this report, we describe a 49-year-old female patient diagnosed with PA, after investigating resistant hypertension and refractory hypokalemia. Abdominal computed tomography scan revealed a 2.5 cm adenoma on the right adrenal vein. AVS was performed under cosyntropin infusion. Aldosterone and cortisol concentrations were obtained from the right and left adrenal veins and inferior vena cava (IVC). Cortisol on each adrenal vein divided by cortisol on IVC confirmed successful cannulation of the left side only, which makes it impossible to calculate the lateralization index (LI). From the data on the left adrenal vein and IVC, the aldosterone-to-cortisol ratio divided by the IVC aldosterone-to-cortisol ratio was less than 1.0, suggesting that the left adrenal vein was suppressed with the excess aldosterone originating from the contralateral side (contralateral suppression index (CSI)). Right adrenalectomy was performed; postoperative hypoaldosteronism was confirmed. This report highlights the importance of CSI obtained in AVS when technical difficulties occur making it impossible to obtain LI, which is most commonly used to decide between surgical and clinical management of PA.

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Subtype prediction of primary aldosteronism by combining aldosterone concentrations in the left adrenal vein and inferior vena cava: a multicenter collaborative study on adrenal venous sampling

Journal of Human Hypertension ◽

10.1038/s41371-017-0015-0 ◽

2017 ◽

Vol 32 (1) ◽

pp. 12-19 ◽

Cited By ~ 3

Author(s):

Yuichi Fujii ◽

◽

Hironobu Umakoshi ◽

Norio Wada ◽

Takamasa Ichijo ◽

...

Keyword(s):

Inferior Vena Cava ◽

Primary Aldosteronism ◽

Inferior Vena ◽

Collaborative Study ◽

Vena Cava ◽

Adrenal Vein ◽

Adrenal Venous Sampling ◽

Venous Sampling

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Regarding “Diagnostic utility of data from adrenal venous sampling for primary aldosteronism despite failed cannulation of the right adrenal vein”

Surgery ◽

10.1016/j.surg.2015.10.033 ◽

2016 ◽

Vol 159 (5) ◽

pp. 1478-1479

Author(s):

Bo-Ching Lee ◽

Chin-Chen Chang

Keyword(s):

Primary Aldosteronism ◽

Adrenal Vein ◽

Adrenal Venous Sampling ◽

Diagnostic Utility ◽

Venous Sampling ◽

The Right

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Diagnostic utility of data from adrenal venous sampling for primary aldosteronism despite failed cannulation of the right adrenal vein

Surgery ◽

10.1016/j.surg.2015.06.048 ◽

2016 ◽

Vol 159 (1) ◽

pp. 267-274 ◽

Cited By ~ 15

Author(s):

Jesse D. Pasternak ◽

Irene Epelboym ◽

Natalie Seiser ◽

Matt Wingo ◽

Max Herman ◽

...

Keyword(s):

Primary Aldosteronism ◽

Adrenal Vein ◽

Adrenal Venous Sampling ◽

Diagnostic Utility ◽

Venous Sampling ◽

The Right

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Low-grade Cortisol Cosecretion Has Limited Impact on ACTH-stimulated AVS Parameters in Primary Aldosteronism

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/clinem/dgaa519 ◽

2020 ◽

Vol 105 (10) ◽

pp. e3776-e3784 ◽

Cited By ~ 1

Author(s):

Samuel Matthew O’Toole ◽

Wing-Chiu Candy Sze ◽

Teng-Teng Chung ◽

Scott Alexander Akker ◽

Maralyn Rose Druce ◽

...

Keyword(s):

Primary Aldosteronism ◽

Vena Cava ◽

Adrenal Vein ◽

Adrenal Venous Sampling ◽

Low Grade ◽

Venous Sampling ◽

Retrospective Case ◽

Tertiary Referral Center ◽

Contralateral Suppression ◽

Control Study

Abstract Context In primary aldosteronism, cosecretion of cortisol may alter cortisol-derived adrenal venous sampling indices. Objective To identify whether cortisol cosecretion in primary aldosteronism alters adrenal venous sampling parameters and interpretation. Design Retrospective case–control study Setting A tertiary referral center Patients 144 adult patients with primary aldosteronism who had undergone both adrenocorticotropic hormone-stimulated adrenal venous sampling and dexamethasone suppression testing between 2004 and 2018. Main Outcome Measures Adrenal venous sampling indices including adrenal vein aldosterone/cortisol ratios and the selectivity, lateralization, and contralateral suppression indices. Results 21 (14.6%) patients had evidence of cortisol cosecretion (defined as a failure to suppress cortisol to ≤50 nmol/L post dexamethasone). Patients with evidence of cortisol cosecretion had a higher inferior vena cava cortisol concentration (P = .01) than those without. No difference was observed between the groups in terms of selectivity index, lateralization index, lateralization of aldosterone excess, or adrenal vein cannulation rate. Conclusions Cortisol cosecretion alters some parameters in adrenocorticotrophic hormone-stimulated adrenal venous sampling but does not result in alterations in patient management.

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C-Arm Computed Tomography-Assisted Adrenal Venous Sampling Improved Right Adrenal Vein Cannulation and Sampling Quality in Primary Aldosteronism

Endocrinology and Metabolism ◽

10.3803/enm.2018.33.2.236 ◽

2018 ◽

Vol 33 (2) ◽

pp. 236 ◽

Cited By ~ 2

Author(s):

Chung Hyun Park ◽

Namki Hong ◽

Kichang Han ◽

Sang-Wook Kang ◽

Cho Rok Lee ◽

...

Keyword(s):

Computed Tomography ◽

Primary Aldosteronism ◽

Adrenal Vein ◽

Adrenal Venous Sampling ◽

Venous Sampling ◽

Vein Cannulation

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Evaluation of right adrenal vein cannulation by computed tomography angiography in 140 consecutive patients undergoing adrenal venous sampling

Acta Endocrinologica ◽

10.1530/eje-13-0741 ◽

2014 ◽

Vol 170 (4) ◽

pp. 601-608 ◽

Cited By ~ 20

Author(s):

Shiro Onozawa ◽

Satoru Murata ◽

Hiroyuki Tajima ◽

Hidenori Yamaguchi ◽

Takahiko Mine ◽

...

Keyword(s):

Computed Tomography ◽

Effective Means ◽

Venous Blood ◽

Univariate Analysis ◽

Adrenal Vein ◽

Adrenal Venous Sampling ◽

Venous Sampling ◽

Adrenal Vein Sampling ◽

Angio Ct ◽

Rate Of Failure

ObjectiveAs it is now known that primary aldosteronism (PA) is more prevalent than was previously recognized, and is a potentially curable cause of hypertension and related cardiovascular diseases, the search for a safe and effective means of its diagnosis has reemerged as a topic of interest. Adrenal venous sampling is the gold standard for diagnosis of PA, but the technique is challenging and the small right adrenal vein can be particularly difficult to cannulate. Our objective was to evaluate the usefulness of computed tomography during angiography (angio-CT) in increasing the success of adrenal venous sampling and to identify factors associated with cannulation failure.DesignRetrospective review.MethodsA total of 140 consecutive patients with suspected PA except Cushing's syndrome treated at a single hospital from June 2008 to May 2013 were included. Catheter misplacement and correct cannulation rates before angio-CT and success rate of sampling after angio-CT were calculated. Univariate analysis for factors related to incorrect cannulation included gender, age, height, weight, BMI, and adrenal nodules. Successful sampling was biochemically defined according to cortisol concentrations in the venous blood samples.ResultsAngio-CT detected misplaced catheters in 13 patients (9.3%). The calculated correct cannulation rate of adrenal vein sampling increased from 86.4% before angio-CT to 95.7% after CT (P<0.001, McNemar's test). Univariate analysis showed a tendency for a higher rate of failure of right adrenal venous sampling in taller patients (P=0.052, Mann–Whitney'sUtest).ConclusionAngio-CT improved success of adrenal venous sampling.

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