scholarly journals Bilateral Aldosterone Suppression in Patients With Right Unilateral Primary Aldosteronism and Review of the Literature

2020 ◽  
Vol 4 (4) ◽  
Author(s):  
Sarah Ying Tse Tan ◽  
Keng Sin Ng ◽  
Colin Tan ◽  
Matthew Chuah ◽  
Meifen Zhang ◽  
...  
Keyword(s):  
Primary Aldosteronism ◽  
High Volume ◽  
Adrenal Vein ◽  
Aldosterone Secretion ◽  
Adrenal Vein Sampling ◽  
Tertiary Center ◽  
The Right ◽  
Repeat Sampling ◽  
Computed Tomography Venography

Abstract Introduction Adrenal vein sampling (AVS) identifies unilateral primary aldosteronism but may occasionally show paradoxically low aldosterone–cortisol ratios bilaterally. Postulated reasons include venous anomalies, fluctuating aldosterone secretion, or superselective cannulation. We report our findings in patients who underwent repeat AVS and reviewed the current literature. Methods We performed a retrospective observational study of patients undergoing AVS in an experienced high-volume tertiary center over a 5-year period. Results From 2015 to 2019, 61 patients underwent sequential cosyntropin-stimulated AVS and all had bilateral successful cannulation (100%). Four of 61 (6.6%) patients had bilaterally low aldosterone–cortisol ratios. Three patients underwent repeat AVS, with all 3 cases demonstrating right-sided lateralization and cure of disease postadrenalectomy. Right-sided disease was also more common in other reports. This may be due to inadvertent superselective cannulation of the short right adrenal vein, resulting in sampling of the adjacent normal gland. Cortisol results cannot detect this problem. In 1 patient, computed tomography venography excluded any accessory right adrenal veins. In another patient, repeat bilateral simultaneous unstimulated AVS was done, and measurements of metanephrines aided in accurately identifying right-sided lateralization. Conclusion In addition to technical difficulties in cannulating the right adrenal vein, we also have to avoid performing superselective cannulation inadvertently. In cases of inconclusive AVS, repeat sampling may identify patients with potentially curable unilateral primary aldosteronism. The role of corticotropin stimulation and metanephrines measurements during repeat AVS requires further study.

scholarly journals Comparison of Cortisol, Androstenedione and Metanephrines to Assess Selectivity and Lateralization of Adrenal Vein Sampling in Primary Aldosteronism

2021 ◽  
Vol 10 (20) ◽  
pp. 4755
Author(s):  
Giulio Ceolotto ◽  
Giorgia Antonelli ◽  
Brasilina Caroccia ◽  
Michele Battistel ◽  
Giulio Barbiero ◽  
...  
Keyword(s):  
Decision Making ◽  
Primary Aldosteronism ◽  
Inferior Vena ◽  
Clinical Decision Making ◽  
Vena Cava ◽  
Clinical Decision ◽  
Selectivity Index ◽  
Adrenal Vein ◽  
Adrenal Vein Sampling ◽  
The Right

Success of adrenal vein sampling (AVS) is verified by the selectivity index (SI), i.e., by a step-up of cortisol levels between the adrenal vein and the infrarenal inferior vena cava samples, beyond a given cut-off. We tested the hypothesis that androstenedione, metanephrine, and normetanephrine, which have higher gradients than cortisol, could increase the rate of AVS studies judged to be bilaterally successful and usable for the clinical decision making. We prospectively compared within-patient, head-to-head, the selectivity index of androstenedione (SIA), metanephrine (SIM), and normetanephrine (SINM), and cortisol (SIC) in consecutive hypertensive patients with primary aldosteronism submitted to AVS. Main outcome measures were rate of bilateral success, SI values, and identification of unilateral PA. We recruited 136 patients (55 + 10 years, 35% women). Compared to the SIC, the SIA values were 3.5-fold higher bilaterally, and the SIM values were 7-fold and 4.4-fold higher on the right and the left side, respectively. With the SIA and the SIM the rate of bilaterally successful AVS increased by 14% and 15%, respectively without impairing the identification of unilateral PA. We concluded that androstenedione and metanephrine outperformed cortisol for ascertaining AVS success, thus increasing the AVS studies useable for the clinical decision making.

scholarly journals Lateralizing Asymmetry of Adrenal Imaging and Adrenal Vein Sampling in Patients With Primary Aldosteronism

2019 ◽  
Vol 3 (7) ◽  
pp. 1393-1402 ◽  
Author(s):  
Norio Wada ◽  
Yui Shibayama ◽  
Takashi Yoneda ◽  
Takuyuki Katabami ◽  
Isao Kurihara ◽  
...  
Keyword(s):  
Primary Aldosteronism ◽  
Diagnostic Techniques ◽  
Concordance Rate ◽  
Adrenal Vein ◽  
Ct Scans ◽  
Adrenal Vein Sampling ◽  
Adrenal Imaging ◽  
Significant Difference ◽  
Nodular Lesions ◽  
The Right

Abstract Context In patients with primary aldosteronism (PA), it remains unclear whether aldosterone-producing adenomas are likely to develop in the left or right adrenal gland. Objective To investigate left-right differences of PA laterality diagnoses via CT imaging and adrenal vein sampling (AVS). Design Retrospective, observational study. Patients From the Japan Primary Aldosteronism Study, 1493 patients with PA were enrolled who underwent CT and ACTH-stimulated AVS. Measurements Left or right adrenal nodular lesion distribution and laterality observed on CT scans and from AVS were noted. Results Both on CT scans and AVS, unilateral results were observed more frequently on the left side than on the right side (25.1% vs 15.4% and 17.3% vs 13.5%, respectively; P < 0.01for both diagnostic techniques). There was no significant difference in the concordance rate for CT and AVS between patients with left and right unilateral nodular lesions observed on CT scans (44.1% and 50.9%, respectively; P = 0.15). In patients with nodules <20 mm, the concordance rate was significantly greater on the right side than the left side (45.8% vs 56.4%; P = 0.03). In patients with bilateral results of AVS, unilateral nodular lesions were detected more frequently on the left side than the right side (17.8% vs 9.4%; P < 0.01). Conclusion These results suggest aldosterone-producing adenomas and nonfunctioning tumors are more likely to develop on the left side in patients with PA and that misdiagnosis of CT-based lateralization may occur more frequently on the left side.

Abstract 277: Mutations in the KCNJ5 Gene Imply a Higher Lateralization Index at Adrenal Vein Sampling for Primary Aldosteronism

Hypertension ◽  
2012 ◽  
Vol 60 (suppl_1) ◽  
Author(s):  
Teresa M Seccia ◽  
Franco Mantero ◽  
Claudio Letizia ◽  
Maniselvan Kuppusamy ◽  
Marlena Barisa ◽  
...  
Keyword(s):  
Primary Aldosteronism ◽  
Somatic Mutations ◽  
Contralateral Side ◽  
Adrenal Vein ◽  
K Channel ◽  
Coding Region ◽  
Aldosterone Secretion ◽  
Adrenal Vein Sampling ◽  
Lateralization Index

Background. The mutations that affect the selectivity filter of the KCNJ5 K+ channel can play a role in triggering and/or maintaining aldosterone oversecretion in primary aldosteronism (PA). We therefore hypothesized that these somatic mutations can be associated with an increased aldosterone secretion from the APA, thus translating in raised plasma aldosterone concentrations (PAC) in the ipsilateral adrenal vein. Aim. To investigate if the lateralization index (LI) at adrenal vein sampling (AVS) is higher in the patients with an APA carrying the mutation (KCNJ5mut), as compared to those without the mutation (KCNJ5wt). Methods. Ninety-two consecutive PA patients who underwent AVS and received diagnosis of APA based on the four corners criteria were recruited. Unequivocal information on the presence or absence of the KCNJ5 mutations was available for each patient. The selectivity index (SI) was calculated as ratio between the right or left adrenal vein PCC (PCCside) and the infrarenal IVC PCC and a cutoff of 2.00 was used. The lateralization index (LI) was calculated in the bilaterally selective AVS as the ratio of PAC/PCC at the APA side to PAC/PCC at the contralateral side. We sequenced the KCNJ5 coding region spanning aminoacids 122 to 199, which include the selectivity filer. Results. The overall prevalence rate of KCNJ5 somatic mutations was 34%; G151R, L168R and T158A mutations were found in 19, 10 and 1 APA respectively. The G151E mutation was not found. The KCNJ5mut and KCNJ5wt groups were similar for gender, age, sK+ levels, while PAC and ARR were higher, and PRA lower (all p<0.05) in the KCNJ5 mut group. In the latter group the LI was higher than in the KCNJ5wt group (29.3± 6.7 vs 16.7±3.9, p< 0.02). This was due to a PAC/PCC ratio which was higher in the adrenal vein ipsilateral to the APA side and lower contralaterally in the KCNJ5mut group. Conclusions. These results provide direct in vivo evidence for a higher aldosterone secretion from APA carrying the KCNJ5 mutations, which translates into higher values of the LI, compared to the tumors without such mutations. Hence, the presence of these KCNJ5 mutations can affect the accuracy of the AVS-based diagnosis of the subtype of PA.

Role of adrenal vein sampling in primary aldosteronism: the Monash Health experience

2015 ◽  
Vol 45 (11) ◽  
pp. 1141-1146 ◽  
Author(s):  
J. Teng ◽  
M. E. Hutchinson ◽  
J. C. G. Doery ◽  
K. W. Choy ◽  
W. Chong ◽  
...  
Keyword(s):  
Primary Aldosteronism ◽  
Adrenal Vein ◽  
Adrenal Vein Sampling

Role of adrenal vein sampling in primary aldosteronism: impact of different diagnostic criteria on subtype diagnosis

2013 ◽  
Author(s):  
Maria-Verena Cicala ◽  
Monica Salva ◽  
Diego Miotto ◽  
Beatrice Rubin ◽  
Raffaele Pezzani ◽  
...  
Keyword(s):  
Diagnostic Criteria ◽  
Primary Aldosteronism ◽  
Adrenal Vein ◽  
Adrenal Vein Sampling

scholarly journals Predicting Surgically Remedial Primary Aldosteronism: Role of Adrenal Scanning, Posture Testing, and Adrenal Vein Sampling

2003 ◽  
Vol 88 (8) ◽  
pp. 3637-3644 ◽  
Author(s):  
E. A. Espiner ◽  
D. G. Ross ◽  
T. G. Yandle ◽  
A. M. Richards ◽  
P. J. Hunt
Keyword(s):  
Primary Aldosteronism ◽  
Adrenal Vein ◽  
Adrenal Vein Sampling

Role of adrenal vein sampling in primary aldosteronism: Impact of imaging, localization, and age

2016 ◽  
Vol 113 (5) ◽  
pp. 532-537 ◽  
Author(s):  
Heather Wachtel ◽  
Salman Zaheer ◽  
Parth K. Shah ◽  
Scott O. Trerotola ◽  
Giorgos C. Karakousis ◽  
...  
Keyword(s):  
Primary Aldosteronism ◽  
Adrenal Vein ◽  
Adrenal Vein Sampling

scholarly journals Subtyping of primary aldosteronism by adrenal vein sampling: effect of acute D2 receptor dopaminergic blockade on adrenal vein cortisol and chromogranin A levels

2011 ◽  
Vol 165 (1) ◽  
pp. 85-90 ◽  
Author(s):  
Teresa M Seccia ◽  
Diego Miotto ◽  
Renzo De Toni ◽  
Valentina Gallina ◽  
Matteo Vincenzi ◽  
...  
Keyword(s):  
Primary Aldosteronism ◽  
Chromogranin A ◽  
Inferior Vena ◽  
D2 Receptor ◽  
Vena Cava ◽  
Adrenal Vein ◽  
Aldosterone Secretion ◽  
Adrenal Vein Sampling ◽  
Plasma Cortisol Concentration ◽  
Design And Methods

BackgroundAdrenal vein sampling (AVS) is the gold standard for identifying the surgically curable forms of primary aldosteronism. Dopamine modulates adrenocortical steroidogenesis and tonically inhibits aldosterone secretion via D2 receptor. However, whether it could also affect the release of cortisol and chromogranin A (ChA), which can be used to assess the selectivity of AVS, is unknown.ObjectiveTo investigate whether metoclopramide increased the release of cortisol and ChA and could thereby improve assessment of the selectivity at AVS.Design and methodsWe investigated the effect of acute D2 antagonism with metoclopramide on cortisol and ChA release from the adrenal gland by comparing the adrenal vein and infrarenal inferior vena cava (IVC) hormone levels at baseline and after metoclopramide administration in 34 consecutive patients undergoing AVS.ResultsMetoclopramide increased plasma aldosterone in the IVC (P<0.00001) and in the adrenal vein blood (P<0.002) but failed to increase plasma cortisol concentration or ChA levels. Therefore, it did not increase the selectivity index based on the measurement of either hormone.ConclusionsThis study shows that the release of cortisol and ChA is not subjected to tonic D2 dopaminergic inhibition. Therefore, these findings lend no evidence for the usefulness of acute metoclopramide administration for enhancing the assessment of the selectivity of blood sampling during AVS with the use of either cortisol or ChA assay.

11C-metomidate PET-CT in primary aldosteronism: five possible indications for a non-invasive alternative to adrenal vein sampling

2015 ◽  
Author(s):  
Andrew S Powlson ◽  
Olympia Koulouri ◽  
Elena Azizan ◽  
Carmela Maniero ◽  
Kevin Taylor ◽  
...  
Keyword(s):  
Primary Aldosteronism ◽  
Adrenal Vein ◽  
Adrenal Vein Sampling ◽  
Non Invasive ◽  
Pet Ct
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