Identification of subsets of Aldosterone-Producing Adenoma (APA) with dynamic Adrenal Vein Sampling (AVS)

Abstract PurposeCatheterization of the right adrenal vein (rt.AdV) to obtain blood samples can often be difficult. The aim of the present study was to investigate whether blood sampling from the inferior vena cava (IVC) at its juncture with the rt.AdV can be an alternative to sampling of blood directly from the rt.AdV.Materials and MethodsThis study included 44 patients diagnosed with primary aldosteronism (PA) in whom AVS with adrenocorticotropic hormone (ACTH) was performed, resulting in a diagnosis of idiopathic hyperaldosteronism (IHA) (n=24), and patients diagnosed with unilateral aldosterone-producing adenoma (APA) (n=20; rt.APA=8, lt.APA=12). In addition to regular blood sampling, blood was also sampled from the IVC, as the substitute rt.AdV [S-rt.AdV]. Diagnostic performance with the conventional lateralized index (LI) and the modified LI using the S-rt.AdV was compared to examine the utility of the modified LI.ResultsThe modified LI of the rt.APA (0.4±0.4) was significantly lower than those of the IHA (1.4±0.7) (p<0.001) and the lt.APA (3.5±2.0) (p<0.001). The modified LI of the lt.APA was significantly higher than those of the IHA (p<0.001) and rt.APA (p<0.001). Sensitivity and specificity to diagnose rt.APA and lt.APA using the modified LI with threshold values of 0.7 and 2.2, respectively, they were 87% and 75%, respectively, and 94% and 94%, respectively.ConclusionThe modified LI has the potential to be an alternative method for rt.AdV sampling in cases in which rt.AdV sampling is difficult. Obtaining the modified LI is extremely simple, which might complement conventional AVS.

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PS 17-04 SUPER-SELECTIVE ADRENAL VEIN SAMPLING IS USEFUL FOR ALDOSTERONE-PRODUCING ADENOMA UNDIAGNOSABLE BY CONVENTIONAL ADRENAL VEIN SAMPLING

Journal of Hypertension ◽

10.1097/01.hjh.0000501266.82877.ae ◽

2016 ◽

Vol 34 (Supplement 1) ◽

pp. e475

Author(s):

Nao Kohata ◽

Isao Kurihara ◽

Sakiko Kobayashi ◽

Kenichi Yokota ◽

Yuko Mitsuishi ◽

...

Keyword(s):

Adrenal Vein ◽

Adrenal Vein Sampling ◽

Aldosterone Producing Adenoma

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A pedunculated aldosterone-producing adenoma drained by an extra vein causing puzzling results of adrenal vein sampling

Clinical Endocrinology ◽

10.1111/cen.13736 ◽

2018 ◽

Vol 89 (2) ◽

pp. 242-244 ◽

Cited By ~ 1

Author(s):

Marieke S. Velema ◽

Tanja Dekkers ◽

Ad R.M.M. Hermus ◽

Henri J.L.M. Timmers ◽

Johan Langenhuijsen ◽

...

Keyword(s):

Adrenal Vein ◽

Adrenal Vein Sampling ◽

Aldosterone Producing Adenoma

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Repeating adrenal vein sampling when neither aldosterone/cortisol ratio exceeds peripheral yields a high incidence of aldosterone-producing adenoma

Journal of Hypertension ◽

10.1097/hjh.0b013e328362add3 ◽

2013 ◽

Vol 31 (10) ◽

pp. 2005-2009 ◽

Cited By ~ 15

Author(s):

Martin Wolley ◽

Richard D. Gordon ◽

Eduardo Pimenta ◽

Nicholas Daunt ◽

Gregory J. Slater ◽

...

Keyword(s):

Adrenal Vein ◽

Adrenal Vein Sampling ◽

High Incidence ◽

Aldosterone Producing Adenoma ◽

Cortisol Ratio

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Lack of influence of somatic mutations on steroid gradients during adrenal vein sampling in aldosterone-producing adenoma patients

Acta Endocrinologica ◽

10.1530/eje-13-0551 ◽

2013 ◽

Vol 169 (5) ◽

pp. 657-663 ◽

Cited By ~ 17

Author(s):

Andrea Oßwald ◽

Evelyn Fischer ◽

Christoph Degenhart ◽

Marcus Quinkler ◽

Martin Bidlingmaier ◽

...

Keyword(s):

Contralateral Side ◽

Adrenal Vein ◽

Genetic Modifiers ◽

Adrenal Vein Sampling ◽

Unilateral Adrenalectomy ◽

Mutation Status ◽

Mutation Carriers ◽

Contralateral Suppression ◽

Aldosterone Producing Adenoma ◽

Index Ratio

ObjectiveAdrenal vein sampling (AVS) is a technically demanding procedure required for the identification of suitable candidates for unilateral adrenalectomy in primary aldosteronism. Recently, somaticKCNJ5K+-channel mutations in aldosterone-producing adenoma (APA) patients have been shown to influence steroid gradients during AVS. These and other recently identified genetic modifiers (ATP1A1andATP2B3) might affect the final diagnosis and treatment of the affected patients.DesignFifty-nine patients with APAs who had undergone successful AVS (adrenal vein cortisol:peripheral cortisol ratio ≥2) and had undergone a mutation analysis of their tumor tissue were studied. The mutation status of the APAs was as follows: 19KCNJ5mutations, eight ATPase mutations (fiveATP1A1and threeATP2B3), and 32 patients with none of these mutations.MethodsThe lateralization index (ratio of aldosterone:cortisol on the side of the adenoma to aldosterone to cortisol on the contralateral side) and the contralateral suppression index (ratio of aldosterone:cortisol on the contralateral side to aldosterone to cortisol in the periphery) were calculated for theKCNJ5-mutated, ATPase-mutated, and theKCNJ5/ATPase mutation-negative APA patients.ResultsThe lateralization indices of the ATPase mutation carriers had a median of 19.9 compared with a median of 16.0 in theKCNJ5mutation carriers and that of 20.5 in theKCNJ5/ATPase mutation-negative patients. The contralateral suppression indices of the ATPase-mutated patients had a median of 0.1 compared with a median of 0.4 in theKCNJ5mutation carriers and that of 0.2 in theKCNJ5/ATPase mutation-negative patients. The differences between the genetic groups were not statistically significant.ConclusionsWe did not find evidence for a clinically important impact of mutation status on steroid gradients during AVS.

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