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.

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

2020 ◽  
Vol 105 (10) ◽  
pp. e3776-e3784 ◽  
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.

scholarly journals Variability of Aldosterone Measurements During Adrenal Venous Sampling for Primary Aldosteronism

2020 ◽  
Author(s):  
Nicholas Yozamp ◽  
Gregory L Hundemer ◽  
Marwan Moussa ◽  
Johnathan Underhill ◽  
Tali Fudim ◽  
...  
Keyword(s):  
Primary Aldosteronism ◽  
Vena Cava ◽  
Adrenal Venous Sampling ◽  
Venous Sampling ◽  
Tertiary Referral Center ◽  
Percentage Difference ◽  
Left And Right ◽  
The Mean ◽  
Lateralization Index ◽  
Cortisol Ratio

Abstract BACKGROUND Variability of aldosterone concentrations has been described in patients with primary aldosteronism. METHODS We performed a retrospective cohort study of 340 patients with primary aldosteronism who underwent adrenal venous sampling (AVS) at a tertiary referral center, 116 of whom also had a peripheral venous aldosterone measured hours before the procedure. AVS was performed by the same interventional radiologist using bilateral, simultaneous sampling, under unstimulated and then stimulated conditions, and each sample was obtained in triplicate. Main outcome measures were: (i) change in day of AVS venous aldosterone from pre-AVS to intra-AVS and (ii) variability of triplicate adrenal venous aldosterone concentrations during AVS. RESULTS Within an average duration of 131 minutes, 81% of patients had a decline in circulating aldosterone concentrations (relative decrease of 51% and median decrease of 7.0 ng/dl). More than a quarter (26%) of all patients had an inferior vena cava aldosterone of ≤5 ng/dl at AVS initiation. The mean coefficient of variation of triplicate adrenal aldosterone concentrations was 30% and 39%, in the left and right veins, respectively (corresponding to a percentage difference of 57% and 73%), resulting in lateralization discordance in up to 17% of patients if the lateralization index were calculated using only one unstimulated aldosterone-to-cortisol ratio rather than the average of triplicate measures. CONCLUSIONS Circulating aldosterone levels can reach nadirs conventionally considered incompatible with the primary aldosteronism diagnosis, and adrenal venous aldosterone concentrations exhibit acute variability that can confound AVS interpretation. A single venous aldosterone measurement lacks precision and reproducibility in 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

Difficulty factors of adrenal venous sampling based on patient characteristics and imaging findings

2021 ◽  
pp. 028418512110340
Author(s):  
Soma Kumasaka ◽  
Hiroyuki Tokue ◽  
Yoshito Tsushima
Keyword(s):  
Inferior Vena ◽  
Vena Cava ◽  
Patient Characteristics ◽  
Sampling Procedure ◽  
Adrenal Vein ◽  
Adrenal Venous Sampling ◽  
Transverse Diameter ◽  
Venous Sampling ◽  
Vertebral Level ◽  
The Right

Background Primary aldosteronism is one of the most common causes of secondary hypertension. Unilateral primary aldosteronism can be treated with adrenalectomy; therefore, determining laterality is essential, for which adrenal venous sampling is considered the gold standard. However, as catheter insertion and sampling at an appropriate venous point is occasionally difficult, it is a time-consuming procedure. Purpose To evaluate the patient characteristics and imaging findings that influence the adrenal venous sampling procedure. Material and Methods A total of 69 patients who underwent adrenal venous sampling between January 2013 and December 2017 were retrospectively analyzed. The procedure was considered difficult if the duration was > 142 min (mean ± standard deviation [SD] of procedure time in this study) and/or proper sampling failed. Anatomical factors such as belly diameter, presence of adrenal nodules, diameter of the right adrenal vein and inferior vena cava, ratio of the diameters of the right adrenal vein to diameter of the inferior vena cava, vertical direction of the right adrenal vein, and vertebral level of the right adrenal vein were evaluated as predictive factors on computed tomography. Results Fifteen patients (21.7%) were considered difficult cases. The factors associated with difficulty were the long transverse diameter of the belly ( P = 0.004) and high vertebral level of the right adrenal vein ( P = 0.032). No statistical differences were observed in any other factors. Conclusion The long transverse diameter of the belly and high vertebral level of the right adrenal vein may prevent completion of the adrenal venous sampling procedure.

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.

CT during Arteriography to Visualize the Right Adrenal Vein for Adrenal Venous Sampling

2015 ◽  
Vol 26 (6) ◽  
pp. 910-914 ◽  
Author(s):  
Sota Oguro ◽  
Seishi Nakatsuka ◽  
Hideki Yashiro ◽  
Subaru Hashimoto ◽  
Kazutoshi Miyashita ◽  
...  
Keyword(s):  
Adrenal Vein ◽  
Adrenal Venous Sampling ◽  
Venous Sampling ◽  
The Right
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