scholarly journals Update: Selective adrenal venous sampling (AVS) – Indication, technique, and significance

2020 ◽  
Author(s):  
Christina Loberg ◽  
Gerald Antoch ◽  
Johannes Stegbauer ◽  
Till Dringenberg ◽  
Andrea Steuwe ◽  
...  
Keyword(s):  
Secondary Hypertension ◽  
Screening Tests ◽  
Adrenal Venous Sampling ◽  
Adrenal Hyperplasia ◽  
Therapeutic Approaches ◽  
Venous Sampling ◽  
Key Points ◽  
Bilateral Adrenal Hyperplasia ◽  
Aldosterone Producing Adenoma ◽  
Adrenal Disease

Background Primary aldosteronism (PA) is the most common detectable cause of secondary hypertension. The majority of patients have either an adrenal aldosterone-producing adenoma (APA) or bilateral adrenal hyperplasia (BAH) demanding different therapeutic approaches. Screening tests and imaging cannot reliably distinguish between a unilateral or bilateral PA. Methods This review article gives an overview concerning etiology, diagnostics, and therapeutic options of PA, and reviews the indication, the technique, and relevance of selective adrenal venous sampling (AVS) in the context of the current literature and the authors’ experience. Results AVS can verify or exclude a unilaterally dominated secretion with a high success rate. Patients with PA and a unilateral APA can be treated curatively by adrenalectomy. Conclusions AVS is an established diagnostic examination for differentiation of unilateral from bilateral adrenal disease in patients with PA. Key Points: Citation Format

scholarly journals Is it Possible to Extirpate Cardiovascular Events in Primary Aldosteronism after Surgical Treatment

2010 ◽  
Vol 1 ◽  
pp. JCM.S6316 ◽  
Author(s):  
Tetsuo Nishikawa ◽  
Yoko Matsuzawa ◽  
Jun Saito ◽  
Masao Omura
Keyword(s):  
Surgical Treatment ◽  
Primary Aldosteronism ◽  
Secondary Hypertension ◽  
Adrenal Venous Sampling ◽  
Venous Sampling ◽  
Partial Adrenalectomy ◽  
Aldosterone Producing Adenoma ◽  
Idiopathic Hyperaldosteronism ◽  
Micro Catheter ◽  
Indication For Treatment

It is well known that primary aldosteronism (PA) due to aldosterone-producing adenoma (APA) is a surgically curable secondary hypertension. Thus, the differential diagnosis between unilateral hyperaldosteronemia due to APA and bilateral hyperaldosteronemia due to idiopathic hyperaldosteronism (IHA) is crucial to decide surgical indication for treatment in PA patients. Adrenal venous sampling (AVS) can diagnose the laterality of hypersecretion of aldosterone in those patients, while it is still impossible to differentiate bilateral hypersecretion of bilateral aldosterone-producing adenomas (Blt-APAs) from that of bilateral hyperplasia of IHA. To solve the problem, we try to develop a new method of supper-selective ACTH-stimulated adrenal venous sampling (SS-ACTH-AVS). We performed SS-ACTH-AVS by using a strip-tip type 2.2 Fr micro-catheter (Koshin Medical Inc. Japan). Adrenal effluents were sampled super-selectively at the central veins and at one or two tributaries of adrenal veins in each gland. We would like to emphasize that SS-ACTH-AVS can precisely analyze the situation of hyperfunction of steroidogenesis in each side of adrenals as well as in some tiny lesions inside the adrenal cortex which are not visible in the CT images. Moreover, we can differentiate Blt-APAs from IHA, and postulate the decision of surgical treatment, such as partial adrenalectomy. Thus, we should perform SS-ACTH-AVS especially in the case demonstrating the existence of bilateral adrenal lesions such as unilateral and bilateral tumors, or even no tumor in both sides in the patients with PA.

scholarly journals Efficacy of adrenal venous sampling is increased by point of care cortisol analysis

2013 ◽  
Vol 2 (4) ◽  
pp. 236-242 ◽  
Author(s):  
Kristin Viste ◽  
Marianne A Grytaas ◽  
Melissa D Jørstad ◽  
Dag E Jøssang ◽  
Eivind N Høyden ◽  
...  
Keyword(s):  
Success Rate ◽  
Point Of Care ◽  
Treatment Options ◽  
Secondary Hypertension ◽  
Adrenal Venous Sampling ◽  
Venous Sampling ◽  
Disease Treatment ◽  
Historical Cohort ◽  
Adrenal Disease ◽  
Representative Samples

Primary aldosteronism (PA) is a common cause of secondary hypertension and is caused by unilateral or bilateral adrenal disease. Treatment options depend on whether the disease is lateralized or not, which is preferably evaluated with selective adrenal venous sampling (AVS). This procedure is technically challenging, and obtaining representative samples from the adrenal veins can prove difficult. Unsuccessful AVS procedures often require reexamination. Analysis of cortisol during the procedure may enhance the success rate. We invited 21 consecutive patients to participate in a study with intra-procedural point of care cortisol analysis. When this assay showed nonrepresentative sampling, new samples were drawn after redirection of the catheter. The study patients were compared using the 21 previous procedures. The intra-procedural cortisol assay increased the success rate from 10/21 patients in the historical cohort to 17/21 patients in the study group. In four of the 17 successful procedures, repeated samples needed to be drawn. Successful sampling at first attempt improved from the first seven to the last seven study patients. Point of care cortisol analysis during AVS improves success rate and reduces the need for reexaminations, in accordance with previous studies. Successful AVS is crucial when deciding which patients with PA will benefit from surgical treatment.

scholarly journals Adrenal venous sampling for primary aldosteronism: laboratory medicine best practice

2017 ◽  
Vol 70 (11) ◽  
pp. 911-916 ◽  
Author(s):  
Gregory Kline ◽  
Daniel T Holmes
Keyword(s):  
Primary Aldosteronism ◽  
Best Practice ◽  
Laboratory Medicine ◽  
Secondary Hypertension ◽  
Adrenal Venous Sampling ◽  
Venous Sampling ◽  
Aldosterone Antagonists ◽  
Bilateral Disease ◽  
Patient Preparation ◽  
Aldosterone Producing Adenoma

Primary aldosteronism (PA) is the most common form of secondary hypertension and is critical to identify because when caused by an aldosterone-producing adenoma (APA) or another unilateral form, it is potentially curable, and even when caused by bilateral disease, antihypertensives more specific to PA treatment can be employed (ie, aldosterone antagonists). Identification of unilateral forms is not generally accomplished with imaging because APAs may be small and elude detection, and coincidental identification of a non-functioning incidentaloma contralateral to an APA may lead to removal of an incorrect gland. For this reason, the method of choice for identifying unilateral forms of PA is selective adrenal venous sampling (AVS) followed by aldosterone and cortisol analysis on collected samples. This procedure is technically difficult from a radiological standpoint and, from the laboratory perspective, is fraught with opportunities for preanalytical, analytical and postanalytical error. We review the process of AVS collection, analysis and reporting. Suggestions are made for patient preparation, specimen labelling practices and nomenclature, analytical dilution protocols, which numerical results to report, and the necessary subsequent calculations. We also identify and explain frequent sources of confusion in the aldosterone and cortisol results and provide an example of tabular reporting to facilitate interpretation and communication between laboratorian, radiologist and clinician.

scholarly journals Computed tomography scan can be misleading in the lateralisation of aldosterone excess

2019 ◽  
Vol 2019 ◽  
Author(s):  
G Leksic ◽  
A M Alduk ◽  
V Molnar ◽  
A Haxhiu ◽  
A Haxhiu ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Gold Standard ◽  
Secondary Hypertension ◽  
Standard Test ◽  
List Type ◽  
Gold Standard Test ◽  
Unilateral Disease ◽  
Bilateral Adrenal Hyperplasia ◽  
Aldosterone Producing Adenoma ◽  
Unreliable Method

Summary Primary aldosteronism (PA) is characterised by aldosterone hypersecretion and represents a common cause of secondary hypertension. During diagnostic evaluation, it is essential to determine the aetiology of PA since the treatment of unilateral and bilateral disease differs significantly. Adrenal vein sampling (AVS) has been implemented as a gold standard test for the diagnosis of PA subtype. However, due to the AVS complexity, costs and limited availability, many patients with PA are being treated based on the computed tomography (CT) findings. In this article, we present two patients with discrepant CT and AVS results, demonstrating that AVS is the only reliable method for localising the source of aldosterone excess. Learning points: CT is an unreliable method for distinguishing aldosterone-producing adenoma (APA) from bilateral adrenal hyperplasia (BAH). CT can be misleading in defining lateralisation of the aldosterone excess in case of unilateral disease (APA). AVS is the gold standard test for defining the PA subtype.

scholarly journals Angiotensin II Type 1 Receptor Autoantibodies in Primary Aldosteronism

2020 ◽  
Vol 52 (06) ◽  
pp. 379-385
Author(s):  
Lucie S. Meyer ◽  
Siyuan Gong ◽  
Martin Reincke ◽  
Tracy Ann Williams
Keyword(s):  
Angiotensin Ii ◽  
Primary Aldosteronism ◽  
Functional Role ◽  
Adrenal Hyperplasia ◽  
Endocrine Hypertension ◽  
Bilateral Adrenal Hyperplasia ◽  
Aldosterone Producing Adenoma ◽  
Agonistic Autoantibodies

AbstractPrimary aldosteronism (PA) is the most common form of endocrine hypertension. Agonistic autoantibodies against the angiotensin II type 1 receptor (AT1R-Abs) have been described in transplantation medicine and women with pre-eclampsia and more recently in patients with PA. Any functional role of AT1R-Abs in either of the two main subtypes of PA (aldosterone-producing adenoma or bilateral adrenal hyperplasia) requires clarification. In this review, we discuss the studies performed to date on AT1R-Abs in PA.

scholarly journals Hypertension and Recurrent Hypokalaemia in Young Woman - A Case Report of Primary Hyperaldosteronism (Conn’s Syndrome)

2018 ◽  
Vol 12 (2) ◽  
pp. 102-104
Author(s):  
Md Nazmul Hasan ◽  
Md Abdur Rahim ◽  
Quazi Mamtaz Uddin Ahmed ◽  
Md Syedul Islam ◽  
Md Rasul Amin ◽  
...  
Keyword(s):  
Case Report ◽  
Young Woman ◽  
Clinical Features ◽  
Resistant Hypertension ◽  
Plasma Aldosterone ◽  
Primary Hyperaldosteronism ◽  
Adrenal Hyperplasia ◽  
Conn’S Syndrome ◽  
Bilateral Adrenal Hyperplasia ◽  
Aldosterone Producing Adenoma

Primary hyperaldosteronism is caused by most commonly due to aldosterone producing adenoma(conn’s syndrome) or bilateral adrenal hyperplasia. Clinical features may be of different type which includes hypertension in young age or resistant hypertension, recurrent hypokalaemia and characterized by increased ratio of plasma aldosterone (ng/dl) to rennin (ng/ml per hour) activity. We report a case of young woman presented with hypertension and recurrent hypokalaemia.University Heart Journal Vol. 12, No. 2, July 2016; 102-104

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