scholarly journals Utility of microcatheter in adrenal venous sampling for primary aldosteronism

2020 ◽  
Vol 93 (1109) ◽  
pp. 20190636
Author(s):  
Yoshifumi Noda ◽  
Satoshi Goshima ◽  
Shoma Nagata ◽  
Hiroshi Kawada ◽  
Yukichi Tanahashi ◽  
...  
Keyword(s):  
Primary Aldosteronism ◽  
Correct Diagnosis ◽  
Plasma Aldosterone ◽  
University Hospital ◽  
Adrenal Venous Sampling ◽  
Common Trunk ◽  
Central Vein ◽  
Venous Sampling ◽  
Institutional Review ◽  
The Right

Objective: To evaluate the utility of microcatheter in adrenal venous sampling (AVS) for assessing aldosterone hypersecretion and the laterality in patients with primary aldosteronism. Methods: This retrospective study was approved by the institutional review board of Gifu University Hospital, and written informed consent was waived. A total of 37 consecutive patients with primary aldosteronism underwent AVS by inserting a microcatheter into the right adrenal central vein (RCV), left adrenal central vein (LCV), and left adrenal common trunk (CT) followed by AVS with 5-French (5-Fr) catheter. The diagnosis of aldosterone hypersecretion was confirmed if the plasma aldosterone level after the administration of cosyntropin injection was ≥14,000 pg/ml. The laterality of aldosterone hypersecretion was determined based on the lateralized and contralateral ratios. Aldosterone hypersecretion and the laterality were diagnosed and compared based on the results obtained using 5-Fr catheter and microcatheter. Results: Plasma aldosterone levels were significantly higher in the RCV, LCV, and CT selected using microcatheter than in the right and left adrenal veins (LAVs) selected using 5-Fr catheter (p < 0.0001–0.029). More aldosterone hypersecretion from the left adrenal gland was observed in the LCV (n = 28) and CT (n = 25) selected using microcatheter compared to the LAV selected using 5-Fr catheter (n = 6) (p < 0.0001). Diagnostic changes in the laterality from unilateral to bilateral were noted in 3 (8%) patients using microcatheter. Conclusion: Microcatheter can effectively assess aldosterone hypersecretion and the laterality, especially in the LAV. Advances in knowledge: Especially for the left adrenal venous sampling, the tip of microcatheter could certainly reach the left adrenal vein orifice compared with 5-Fr catheter, therefore correct diagnosis is made and this leads to appropriate treatment.

scholarly journals A case of Williams syndrome with suspected coexisting ectopic aldosterone-producing tumor in the liver

2020 ◽  
Vol 2020 ◽  
Author(s):  
Shuhei Baba ◽  
Arina Miyoshi ◽  
Shinji Obara ◽  
Hiroaki Usubuchi ◽  
Satoshi Terae ◽  
...  
Keyword(s):  
Williams Syndrome ◽  
Primary Aldosteronism ◽  
High Plasma ◽  
Plasma Aldosterone ◽  
Adrenal Tumors ◽  
Venous Sampling ◽  
Plasma Aldosterone Concentration ◽  
Adrenal Rest Tumor ◽  
Adrenal Rest ◽  
The Right

Summary A 31-year-old man with Williams syndrome (WS) was referred to our hospital because of a 9-year history of hypertension, hypokalemia, and high plasma aldosterone concentration to renin activity ratio. A diagnosis of primary aldosteronism (PA) was clinically confirmed but an abdominal CT scan showed no abnormal findings in his adrenal glands. However, a 13-mm hypervascular tumor in the posterosuperior segment of the right hepatic lobe was detected. Adrenal venous sampling (AVS) subsequently revealed the presence of an extended tributary of the right adrenal vein to the liver surrounding the tumor. Segmental AVS further demonstrated a high plasma aldosterone concentration (PAC) in the right superior tributary vein draining the tumor. Laparoscopic partial hepatectomy was performed. The resected tumor histologically separated from the liver was composed of clear cells, immunohistochemically positive for aldesterone synthase (CYP11B2), and subsequently diagnosed as aldosterone-producing adrenal adenoma. After surgery, his blood pressure, serum potassium level, plasma renin activity and PAC were normalized. To the best of our knowledge, this is the first report of WS associated with PA. WS harbors a high prevalence of hypertension and therefore PA should be considered when managing the patients with WS and hypertension. In this case, the CT findings alone could not differentiate the adrenal rest tumor. Our case, therefore, highlights the usefulness of segmental AVS to distinguish adrenal tumors from hepatic adrenal rest tumors. Learning points: Williams syndrome (WS) is a rare genetic disorder, characterized by a constellation of medical and cognitive findings, with a hallmark feature of generalized arteriopathy presenting as stenoses of elastic arteries and hypertension. WS is a disease with a high frequency of hypertension but the renin-aldosterone system in WS cases has not been studied at all. If a patient with WS had hypertension and severe hypokalemia, low PRA and high ARR, the coexistence of primary aldosteronism (PA) should be considered. Adrenal rest tumors are thought to arise from aberrant adrenal tissues and are a rare cause of PA. Hepatic adrenal rest tumor (HART) should be considered in the differential diagnosis when detecting a mass in the right hepatic lobe. Segmental adrenal venous sampling could contribute to distinguish adrenal tumors from HART.

scholarly journals Adrenal Venous Sampling in Primary Aldosteronism: The Usefulness of Contralateral Suppression Index

2019 ◽  
Vol 2019 ◽  
pp. 1-4 ◽  
Author(s):  
Natalia Treistman ◽  
Aline Barbosa Moraes ◽  
Stéphanie Cozzolino ◽  
Patrícia de Fatima dos Santos Teixeira ◽  
Leonardo Vieira Neto
Keyword(s):  
Primary Aldosteronism ◽  
Vena Cava ◽  
Adrenal Vein ◽  
Adrenal Venous Sampling ◽  
Venous Sampling ◽  
Successful Cannulation ◽  
Contralateral Suppression ◽  
The Right ◽  
Cortisol Ratio ◽  
Suppression Index

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.

Adrenal Vein Catecholamine Levels and Ratios: Reference Intervals Derived from Patients with Primary Aldosteronism

2017 ◽  
Vol 49 (06) ◽  
pp. 418-423 ◽  
Author(s):  
Candy Sze ◽  
Samuel O’Toole ◽  
Roger Tirador ◽  
Scott Akker ◽  
Matthew Matson ◽  
...  
Keyword(s):  
Primary Aldosteronism ◽  
Imaging Techniques ◽  
False Negative ◽  
False Negative Rate ◽  
Reference Intervals ◽  
Adrenal Venous Sampling ◽  
Venous Sampling ◽  
Few Data ◽  
Histological Confirmation ◽  
The Right

AbstractPhaeochromocytoma localisation is generally reliably achieved with modern imaging techniques, particularly in sporadic cases. On occasion, however, there can be diagnostic doubt due to the presence of bilateral adrenal abnormalities, particularly in patients with mutations in genes predisposing them to the development of multiple phaeochromocytomas. In such cases, surgical intervention is ideally limited to large or functional lesions due to the long-term consequences associated with hypoadrenalism. Adrenal venous sampling (AVS) for catecholamines has been used in this situation to guide surgery, although there are few data available to support diagnostic thresholds. Retrospective analyses of AVS results from 2 centres were carried out. A total of 172 patients (88 men, 84 women) underwent AVS under cosyntropin stimulation for the diagnosis of established primary aldosteronism (PA) with measurement of adrenal and peripheral venous cortisol, aldosterone and catecholamines. Six patients (3 men, 3 women) with phaeochromocytoma underwent AVS for diagnostic purposes with subsequent histological confirmation. Reference intervals for the adrenal venous norepinephrine to epinephrine ratio were created from the PA group. Using the 97.5th centile (1.21 on the left, 1.04 on the right), the false negative rate in the phaeochromocytoma group was 0%. In conclusion, this study describes the largest dataset of adrenal venous catecholamine measurements and provides reference intervals in patients without phaeochromocytoma. This strengthens the certainty with which conclusions related to adrenal venous sampling for catecholamines can be drawn, acknowledging the procedure is not part of the routine diagnostic workup and is an adjunct for use only in difficult clinical cases.

scholarly journals Steroidogenic Activity in Unresected Adrenals Associated With Surgical Outcomes in Primary Aldosteronism

Hypertension ◽  
2021 ◽  
Vol 77 (5) ◽  
pp. 1638-1646
Author(s):  
Kazuki Nakai ◽  
Yuya Tsurutani ◽  
Kosuke Inoue ◽  
Seishi Matsui ◽  
Kohzoh Makita ◽  
...  
Keyword(s):  
Adrenal Gland ◽  
Primary Aldosteronism ◽  
Surgical Outcomes ◽  
Area Under The Curve ◽  
Adrenal Venous Sampling ◽  
Central Vein ◽  
Venous Sampling ◽  
Unilateral Adrenalectomy ◽  
Complete Group ◽  
Success Group

In patients with primary aldosteronism diagnosed with unilateral lesions through adrenal venous sampling, excess aldosterone occasionally persists after adrenalectomy. We investigated whether aldosterone values from unresected adrenals would be associated with postoperative outcomes. Overall, 102 primary aldosteronism patients, who underwent segmental adrenal venous sampling and unilateral adrenalectomy, were assessed for biochemical success (as outlined in the PASO [Primary Aldosteronism Surgical Outcomes] Study) at 1 year after surgery by using the saline infusion test. We divided patients into the biochemical complete or incomplete success group. Eighty-seven and 15 patients had complete and incomplete biochemical success, respectively. The biochemical incomplete group, compared with the biochemical complete group, had higher maximum aldosterone in tributary veins (11 000 versus 7030 pg/mL, P =0.006), maximum aldosterone/cortisol in tributary veins (18.05 versus 9.13, P <0.001), aldosterone in the central vein (9260 versus 5800 pg/mL, P =0.011), and aldosterone/cortisol in the central vein (13.67 versus 8.08, P <0.001) of the unresected adrenal gland. In logistic regression analyses, maximum aldosterone/cortisol in tributary veins had the highest area under the curve (0.780). Aldosterone/cortisol in the central vein had a nearly equivalent area under the curve (0.775). The lateralization index showed no significant differences between the groups. The clinical incomplete group similarly had higher aldosterone and aldosterone/cortisol in the unresected adrenal gland than did the clinical complete group. Therefore, steroidogenic activity in unresected adrenals (eg, absolute aldosterone value and aldosterone/cortisol) were associated with surgical outcomes. Our results may aid clinicians in determining the surgical application for primary aldosteronism.

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

Surgery ◽  
2016 ◽  
Vol 159 (1) ◽  
pp. 267-274 ◽  
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

scholarly journals Comparisons of plasma aldosterone and renin data between an automated chemiluminescent immunoanalyzer and conventional radioimmunoassays in the screening and diagnosis of primary aldosteronism

PLoS ONE ◽  
2021 ◽  
Vol 16 (7) ◽  
pp. e0253807
Author(s):  
Naohisa Tamura ◽  
Erika Watanabe ◽  
Rumi Shirakawa ◽  
Eiji Nakatani ◽  
Kanako Yamada ◽  
...  
Keyword(s):  
Primary Aldosteronism ◽  
Plasma Aldosterone ◽  
Adrenal Venous Sampling ◽  
Regression Equations ◽  
Venous Sampling ◽  
Characteristic Analysis ◽  
Optimal Cutoff ◽  
Endocrine Society ◽  
Plasma Aldosterone Concentration ◽  
Confirmatory Tests

Determining values of plasma renin activity (PRA) or plasma active renin concentration (ARC), plasma aldosterone concentration (PAC), and aldosterone-to-renin ratio (ARR) is essential to diagnose primary aldosteronism (PA), but it takes several days with conventional radioimmunoassays (RIAs). Chemiluminescent enzyme immunoassays for PAC and ARC using the Accuraseed® immunoanalyzer facilitated the determination, but relations between Accuraseed® immunoanalyzer-based and RIA-based values in samples of PA confirmatory tests and adrenal venous sampling remained to be elucidated. We addressed this issue in the present study. This is a prospective, cross-sectional study. ARC and PAC values were measured by the Accuraseed® immunoanalyzer in samples, in which PRA and PAC values had been measured by the PRA-FR® RIA and SPAC®-S Aldosterone kits, respectively. The relations between Accuraseed® immunoanalyzer-based and RIA-based values were investigated with regression analyses. The optimal cutoff of Accuraseed® immunoanalyzer-based ARR for PA screening was determined by the receiver operating characteristic analysis. After log-log transformations, linear relations with high coefficients of determination were observed between Accuraseed® immunoanalyzer-based and RIA-based data of renin and aldosterone. Following the PA guidelines of Japan Endocrine Society, Accuraseed® immunoanalyzer-based cutoffs were calculated from the regression equations: the basal PAC for PA screening >12 ng/dL, PAC for the saline infusion test >8.2 ng/dL, ARC for the furosemide-upright test <15 pg/mL, and ARR for the captopril challenge test >3.09 ng/dL per pg/mL. The optimal cutoff of Accuraseed® immunoanalyzer-based ARR for PA screening was >2.43 ng/dL over pg/mL not to overlook bilateral PA patients. The present study provided conversion formulas between Accuraseed® immunoanalyzer-based and RIA-based values of renin, aldosterone, and ARR, not only in basal samples but also in samples of PA confirmatory tests and adrenal venous sampling. Although validation studies are awaited, the present study will become priming water of harmonization of renin and aldosterone immunoassays.

scholarly journals SUN-202 Is a “Failed” Adrenal Venous Sampling Useful for Surgical Decision Making in Primary Hyperaldosteronism?

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Rania El Mais ◽  
Runa Acharya
Keyword(s):  
Adrenal Adenoma ◽  
Plasma Aldosterone ◽  
Primary Hyperaldosteronism ◽  
Adrenal Vein ◽  
Adrenal Venous Sampling ◽  
Uncontrolled Hypertension ◽  
Venous Sampling ◽  
Plasma Aldosterone Concentration ◽  
Salt Loading ◽  
The Right

Abstract Background Adrenal venous sampling (AVS) is important in differentiating unilateral vs bilateral primary hyperaldosteronism. A limitation is the difficult cannulation of the right adrenal vein (RAV). A study in 2016(1) investigated the usefulness of AVS with failed right sided cannulation. The investigators calculated the ratios of plasma aldosterone and cortisol in the periphery (IVC) and in the left adrenal vein (LAV), then corrected the aldosterone/cortisol ratio of the LAV for that of the IVC with the following equation: LAV/ IVC = [aldosterone in LAV/cortisol in LAV] / [aldosterone in IVC/ cortisol in IVC]. A LAV/IVC ratio ≥5.5 and ≤0.5 predicted unilateral aldosterone hypersecretion on left and right side respectively with a 100% specificity and positive predictive value. Clinical case We present a case of a 51-year-old patient with primary hyperaldosteronism and a failed right sided cannulation. Patient presented with uncontrolled hypertension of 10 years and hypokalemia. His blood pressure (BP) was 190/100 on amlodipine, lisinopril, atenolol, hydralazine and spironolactone. Screening labs obtained off spironolactone and atenolol showed: Aldosterone 18.5ng/dl(0-30), renin 0.215ng/ml(0.167-5.738), plasma aldosterone concentration (PAC)/ plasma renin concentration (PRC) 86. CT abdomen showed a 1.2cmX1cm left adrenal adenoma. A 24-hour urine collection without salt loading showed an aldosterone of 43.46 microg/L (0-19). He underwent an AVS with a failed RAV cannulation with the following results: IVC: cortisol=17.2 microg/dl, aldosterone= 8.9ng/dl, aldosterone/cortisol= 0.52 LAV: cortisol=420, aldosterone=2860, aldosterone/cortisol=6.8. Partial left adrenalectomy was performed. Pathology showed a benign adenoma. Although his BP initially improved, over several weeks, his BP was high again, and he had a recurrence of hypokalemia. A repeat PAC/PRC of 80 confirmed persistent hyperaldosteronism. He refused further interventions. Eplerenone was added resulting in BP control. Conclusion Based on the above study, his LAV/IVC of 13 predicts the source to be the left adrenal gland. However, this ratio did not apply in our patient and should be utilized carefully. References: 1.Pasternak JD, Epelboym I, Seiser N, Wingo M, Herman M, Cowan V, et al. Diagnostic utility of data from adrenal venous sampling for primary aldosteronism despite failed cannulation of the right adrenal vein. Surgery. 2016;159(1):267-73.

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