J Korean Endocr Soc.  2007 Dec;22(6):428-435. 10.3803/jkes.2007.22.6.428.

The Clinical Implication and Problems of Adrenal Vein Sampling in Patients with Primary Aldosteronism

• Lee JS
• Kang MY
• Kim SW
• Shin CS
• Kim SY
• Chung JW

• KMID: 1958907
• DOI: http://doi.org/10.3803/jkes.2007.22.6.428

Abstract

BACKGROUND: Recently, the significance of primary aldosteronism is being recognized due to an increase in its incidence and its complications. However, it is difficult to differentiate primary aldosteronism based on radiological studies as the size of an aldosterone producing adenoma (APA) is small, and nonfunctioning adrenal incidentalomas are common. Adrenal vein sampling (AVS) has been considered as the gold standard for differentiating an aldosterone producing adenoma (APA) from bilateral idiopathic adrenal hyperplasia (BAH). The clinical implications and problems associated with AVS have not yet been reported in Korea. METHOD: Clinical data of 28 patients with primary aldosteronism who had undergone AVS in a hospital from 1995 to 2006 were retrospectively analyzed. RESULT: The study group comprised 13 males (46.4%) and 15 females (53.5%), with a mean age of 44.5 +/- 11.9 years. Clinical data indicated that 19 patients (67.9%) had APA and nine patients (32.1%) had BAH. AVS data demonstrated that 11 patients had APA and five patients had BAH. Two patients were not diagnosed despite successful AVS. AVS was not successful in 10 patients (37.5%); AV catheterization failed in two patients, was not selective in seven patients on the right side, and was not selective in one patient on the left side.
CONCLUSION
AVS was helpful in primary aldosteronism patients with inconclusive CT and MRI findings. Selectivity of AVS should be appropriately assessed because of the technical problem of selective catheterization.

Keyword

adrenal vein sampling; primary aldosteronism

MeSH Terms

Adenoma
Aldosterone
Catheterization
Catheters
Female
Humans
Hyperaldosteronism*
Hyperplasia
Incidence
Korea
Magnetic Resonance Imaging
Male
Retrospective Studies
Veins*
Aldosterone

Reference

1. Pickering GW. Hypertension. 1996. 1st ed. London: J & A Churchill;62.

2. Laragh JH. Vasoconstriction-volume analysis for understanding and treating hypertension; the use of renin and aldosterone profiles. Am J Med. 1973. 55:261.

3. Conn JW, Knopf RF, Nesbit RM. Clinical characteristics of primary aldosteronism from an analysis of 145 cases. Am J Surg. 1964. 107:159–172.

4. Shimizu A, Aoi W, Akahoshi M, Utsunomiya T, Doi Y, Suzuki S, Kuramochi M, Hashiba K. Elevation of plasma renin activity during pregnancy and rupture of a dissecting aortic aneurysm in a patient with primary aldosteronism. Jpn Heart J. 1983. 24:995–1006.

5. Aloia JF, Beutow G. Malignant hypertension with aldosteronoma producing adenoma. Am J Med Sci. 1974. 268:241–245.

6. Bryer A, Miller JL. Conn's syndrome presenting as a subarachnoid haemorrhage. A case report. S Afr Med J. 1982. 62:249–250.

7. Matsuda K, Shimamoto K, Ura N, Ogata H, Shizukuda Y, Iwakura M, Nozawa A, Kikuchi K, Iimura O. A case of primary aldosteronism with chronic renal failure undergoing hemodialysis treatment. Endocrinol Jpn. 1989. 36:681–686.

8. Kloppenborg PW, Drayer JI, Van Haelst AJ, Van't Laar A, Smals AG, Benraad TJ. Primary aldosteronism, idiopathic aldosteronism, and "low-renin" benign essential hypertension, A retrospective study. Neth J Med. 1974. 17:239–247.

9. McAlister FA, Lewanczuk RZ. Primary hyperaldosteronism and adrenal incidentaloma: an argument for physiologic testing before adrenalectomy. Can J Surg. 1998. 41:299–305.

10. Magill SB, Raff H, Shaker JL, Brickner RC, Knechtges TE, Kehoe ME, Findling JW. Comparison of adrenal vein sampling and computed tomography in the differentiation of primary aldosteronism. J Clin Endocrinol Metab. 2001. 86:1066–1071.

11. Ou YC, Yang CR, Chang CL, Hwang TI, Chang CH, Wu HC, Ho YJ, Kao CH. Comparison of five modalities in localization of primary aldosteronism. Zhong-hua Yi Xue Za Zhi. 1994. 53:7–12.

12. Young WF, Klee GG. Primary aldosteronism; diagnostic evaluation. Endocrinol Metab Clin North Am. 1988. 17:367–395.

13. Gross MD, Falke THM, Shapiro B, Sandler MP. Sandler MP, Patton JA, Gross MD, Shapiro B, Falke THM, editors. Adrenal glands. Endocrine imaging. 1992. Norwalk CT: Appleton & Lange;271–349.

14. Reznek RH, Armstrong P. The adrenal gland. Clin Endocrinol (Oxf). 1994. 40:561–576.

15. Blumenfeld JD, Sealey JE, Schlussel Y, Vaughan ED Jr, Sos TA, Atlas SA, Muller FB, Acevedo R, Ulick S, Laragh JH. Diagnosis and treatment of primary hyperaldosteronism. Ann Intern Med. 1994. 121:877–885.

16. Young WF, Stanson AW, Thompson GB, Grant CS, Farley DR, van Heerden JA. Role for adrenal venous sampling in primary aldosteronism. Surgery. 2004. 136:1227–1235.

17. Radin DR, Manoogian C, Nadler JL. Diagnosis of primary hyperaldosteronism: importance of correlating CT findings with endocrinologic studies. Am J Roentgenol. 1992. 158:553–557.

18. Phillips JL, Walther MM, Pezzullo JC, Rayford W, Choyke PL, Berman AA, Linehan WM, Doppman JL, Gill JR Jr. Predictive Value of Preoperative Tests in Discriminating Bilateral Adrenal Hyperplasia from an Aldosterone-Producing Adrenal Adenoma. J Clin Endocinol Metab. 2000. 85:4526–4533.

19. Harper R, Ferrett CG, McKnight JA, McIlrath EM, Russell CF, Sheridan B, Atkinson AB. Accuracy of CT scanning and adrenal vein sampling in the preoperative localization of adlosterone secreting adrenal adenomas. QJM. 1999. 92:643–650.

20. Weinberger MH, Grim CE, Hollifield JW, Kem DC, Ganguly A, Kramer NJ, Yune HY, Wellman H, Donohue JP. Primary aldosteronism: diagnosis, localization, and treatment. Ann Intern Med. 1979. 90:386–395.

21. Gleason PE, Weinberger MH, Pratt JH, Bihrle R, Dugan J, Eller D, Donohue JP. Evaluation of diagnostic tests in the differential diagnosis of primary aldosteronism: unilateral adenoma versus bilateral micronodular hyperplasia. J Urol. 1993. 150:1365–1368.

22. Dunnick NR, Doppman JL, Gill JR Jr, Strott CA, Keiser HR, Brennan MF. Localization of functional adrenal tumors by computed tomography and venous sampling. Radiology. 1982. 142:429–433.

23. Doppman JL, Gill JR Jr. Hyperaldosteronism: sampling the adrenal veins. Radiology. 1996. 198:309–312.

24. Pagny JY, Chatellier G, Raynaud A, Plouin PF, Corvol P. Localization of primary hyperaldosteronism. Ann Endocrinol (Paris). 1988. 49:340–343.

25. Celen O, O'Brien MJ, Melby JC, Beazley RM. Factors influencing outcome of surgery for primary aldosteronism. Arch Surg. 1996. 131:646–650.

26. Monkhouse WS, Khalique A. The adrenal and renal veins of man and their connections with azygos and lumbar veins. J Anat. 1986. 146:105–115.