Adrenal Venous Sampling

Vonend, Oliver; Ockenfels, N; Gao, Xing; Allolio, Bruno; Lang, Katharina; Mai, Knut; Quack, Ivo; Saleh, Andreas; Degenhart, Christoph; Seufert, Jochen; Seiler, Lysann; Beuschlein, Felix; Quinkler, Marcus; Podrabský, P; Bidlingmaier, Martin; Lorenz, Reinhard; Reincke, Martín; Rump, Lars Christian

doi:10.1161/hypertensionaha.110.168484

Cited by 204 publications

(84 citation statements)

References 28 publications

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“…Previous studies determined the clinical impact of adrenalectomy chosen based on CT alone or CT plus AVS (5,14,(17)(18)(19). Those authors reported that the reduction in BP, number of hypertensive medications, plasma aldosterone, and potassium normalization at follow-up were equivalent in the two groups and concluded that CT could be used to diagnose nodules >10 mm reliably and that AVS should be used when CT is normal or both adrenal glands are abnormal (29,30).…”

Section: Discussionmentioning

confidence: 99%

Adrenal venous sampling for stratifying patients for surgery of adrenal nodules detected using dynamic contrast enhanced CT

Kim

Lee³

et al. 2013

Diagn Interv Radiol

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ORIGINAL ARTICLE PURPOSE We aimed to assess the value of adrenal venous sampling (AVS) for diagnosing primary aldosteronism (PA) subtypes in patients with a unilateral nodule detected on adrenal computed tomography (CT) and scheduled for adrenalectomy. MATERIALS AND METHODSThis retrospective study included 80 consecutive patients with PA undergoing CT and AVS. Different lateralization indices were assessed, and a cutoff established using receiver operating characteristic curve analysis. The value of CT alone versus CT with AVS for differentiating PA subtypes was compared. The adrenalectomy outcome was assessed, and predictors of cure were determined using univariate analysis. RESULTS AVS was successful in 68 patients. A cortisol-corrected aldosterone affected-to-unaffected ratio cutoff of 2.0 and affected-to-inferior vena cava ratio cutoff of 1.4 were the best lateralization indices, with accuracies of 82.5% and 80.4%, respectively. CT and AVS diagnosed 38 patients with aldosterone-producing adenomas, five patients with unilateral adrenal hyperplasia, and 25 patients with bilateral adrenal hyperplasia. Of the 52 patients with a nodule detected on CT, subsequent AVS diagnosed bilateral adrenal hyperplasia in 14 patients (27%). Compared to the results of combining CT with AVS, the accuracy of CT alone for diagnosing aldosterone-producing adenomas was 71.1% (P < 0.001). The cure rate for hypertension after adrenalectomy was 39.2%, with improvement in 53.5% of patients. On univariate analysis, predictors of persistent hypertension were male gender and preoperative systolic blood pressure. CONCLUSIONTo avoid inappropriate surgery, AVS is necessary for diagnosing unilateral nodules with aldosterone hypersecretion detected by CT. P rimary aldosteronism (PA) is the most common form of secondary hypertension, with a prevalence of 5%-11% (1-3). PA is due primarily to the hypersecretion of aldosterone by an aldosterone-producing adenoma (APA) or unilateral (primary) adrenal hyperplasia (UAH), which constitute 30%-40% of cases; the remainder are presumed to be secondary to idiopathic bilateral adrenal hyperplasia (BAH) (1, 4, 5). APA and UAH are two forms of unilateral aldosterone hypersecretion, and both are curable with adrenalectomy. BAH induces bilateral aldosterone hypersecretion, and anti-aldosterone drugs are used in its medical management (5-7).The plasma aldosterone-to-renin ratio is used to screen for PA in patients at high risk for PA (8). Recent guidelines recommend using computed tomography (CT) of the adrenal gland to categorize the subtype after confirming PA. However, CT cannot reliably visualize a microadenoma or distinguish between an incidentaloma or BAH and APA. It has been suggested that adrenal venous sampling (AVS) be performed to determine the subtype of PA and to differentiate between unilateral and bilateral production of aldosterone preoperatively (9). AVS to measure the adrenal vein aldosterone and cortisol is the gold standard for lateralizing aldosterone secretion (10). Lateralization is define...

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Section: Discussionmentioning

confidence: 99%

Adrenal venous sampling for stratifying patients for surgery of adrenal nodules detected using dynamic contrast enhanced CT

Kim

Lee³

et al. 2013

Diagn Interv Radiol

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“…6,11,12 Moreover, AVS is an invasive technique that is not well standardized between centers and heavily depends on the expertise of the interventional radiologist. 13,14 AVS furthermore requires the use of contrast agents in a patient population that often experiences impaired renal function. 15 To date, proposed clinical prediction scores cannot replace AVS.…”

Section: Hypertensionmentioning

confidence: 99%

Targeting CXCR4 (CXC Chemokine Receptor Type 4) for Molecular Imaging of Aldosterone-Producing Adenoma

Heinze¹,

Fuß²,

Mulatero³

et al. 2018

Hypertension

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Primary aldosteronism is the most frequent cause of secondary hypertension and is associated with increased morbidity and mortality compared with hypertensive controls. The central diagnostic challenge is the differentiation between bilateral and unilateral disease, which determines treatment options. Bilateral adrenal venous sampling, currently recommended for differential diagnosis, is an invasive procedure with several drawbacks, making it desirable to develop novel noninvasive diagnostic tools. When investigating the expression pattern of chemokine receptors by quantitative real-time polymerase chain reaction and immunohistochemistry, we observed high expression of CXCR4 (CXC chemokine receptor type 4) in aldosterone-producing tissue in normal adrenals, adjacent adrenal cortex from adrenocortical adenomas, and in aldosterone-producing adenomas (APA), correlating strongly with the expression of CYP11B2 (aldosterone synthase). In contrast, CXCR4 was not detected in the majority of nonfunctioning adenomas that are frequently found coincidently. The specific CXCR4 ligand 68Ga-pentixafor has recently been established as radiotracer for molecular imaging of CXCR4 expression and showed strong and specific binding to cryosections of APAs in our study. We further investigated 9 patients with primary aldosteronism because of APA by 68Ga-pentixafor–positron emission tomography. The tracer uptake was significantly higher on the side of increased adrenocortical aldosterone secretion in patients with APAs compared with patients investigated by 68Ga-pentixafor–positron emission tomography for other causes. Molecular imaging of aldosterone-producing tissue by a CXCR4-specific ligand may, therefore, be a highly promising tool for noninvasive characterization of patients with APAs.

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“…AVS was carried out after 2-3 h of resting in supine position between 0800 and 1200 h as described previously (17). Selective AVS was assumed for the purpose of this study, if cortisol of the adrenal vein was 100% higher than cortisol in the inferior vena cava (cortisol in adrenal vein/cortisol in inferior vena cava R2.0).…”

Section: Design and Patientsmentioning

confidence: 99%

Post-saline infusion test aldosterone levels indicate severity and outcome in primary aldosteronism

Weigel

Riester

Hanslik

et al. 2015

European Journal of Endocrinology

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Objective: The saline infusion test (SIT) is widely used as a confirmatory test for primary aldosteronism (PA). SIT results are judged as follows: post-test aldosterone levels !50 ng/l exclude PA, whereas levels O50 ng/l confirm PA. We hypothesized that post-SIT aldosterone concentrations indicate the severity of PA and might predict outcome. Design: The study includes 256 PA patients of the German Conn's Registry who prospectively underwent SIT. The data of 126 patients with complete follow-up of 1.2G0.3 years after diagnosis were analyzed. The patients were divided into two groups with post-SIT aldosterone levels of 50-100 ng/l (group 1; nZ38) and of O100 ng/l (group 2; nZ88). Results: Patients in group 2 had a significantly shorter duration of hypertension (7.5 vs 11.7 years (median), PZ0.014), higher systolic blood pressure (BP; 151G16 vs 143G17 mmHg, PZ0.036), lower serum potassium (3.3G0.6 vs 3.5G0.4 mmol/l, PZ0.006), higher 24-h urine protein excretion (7.4 vs 5.4 mg/dl (median), PZ0.012), and were more often female (PZ0.038). They showed more often unilateral disease (P!0.005) with larger tumors (14G10 vs 7G10 mm, PZ0.021), underwent more often adrenalectomy (75% vs 37%, P!0.005), required a lower number of antihypertensive drugs after adrenalectomy (1.2G1.2 vs 2.5G1.4, PZ0.001), had a faster normalization of urinary protein excretion (with medical treatment PZ0.049; with Adx P!0.005) at follow-up, and more frequently underlying well-characterized mutation (PZ0.047). Conclusions: PA patients with post-SIT aldosterone levels of O100 ng/l have a more rapid development of PA caused more frequently by unilateral disease with larger aldosterone-producing adenomas. However, this group of patients may have a significantly better outcome following specific treatment.

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Adrenal Venous Sampling

Cited by 204 publications

References 28 publications

Adrenal venous sampling for stratifying patients for surgery of adrenal nodules detected using dynamic contrast enhanced CT

Adrenal venous sampling for stratifying patients for surgery of adrenal nodules detected using dynamic contrast enhanced CT

Targeting CXCR4 (CXC Chemokine Receptor Type 4) for Molecular Imaging of Aldosterone-Producing Adenoma

Post-saline infusion test aldosterone levels indicate severity and outcome in primary aldosteronism

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