Intra-adrenal Aldosterone Secretion: Segmental Adrenal Venous Sampling for Localization

Satani, Nozomi; Ota, Hideki; Seiji, Kazumasa; Morimoto, Ryo; Kudo, Masataka; Iwakura, Yoshitsugu; Ono, Yoshikiyo; Nezu, Masahiro; Omata, Kei; Ito, Sadayoshi; Satoh, Fumitoshi; Takase, Kei

doi:10.1148/radiol.2015142159

Cited by 59 publications

(50 citation statements)

References 26 publications

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“…19,20 To overcome this disadvantage, super-selective segmental adrenal vein branches AVS would be required. 21 However, this technique is highly demanding and is only available in few specialized centers. 22 In addition to performing short synacthen testing postoperatively, preoperative testing for residual adrenal function in the gland bearing the AH by performing adrenal scintiscan using 131 Inor cholesterol without dexamethasone suppression could be considered.…”

Section: Discussionmentioning

confidence: 99%

Clinical Management and Outcomes of Adrenal Hemorrhage Following Adrenal Vein Sampling in Primary Aldosteronism

et al. 2016

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Aldosterone-producing adenoma and bilateral adrenal hyperplasia account for >90% of all primary aldosteronism cases. Distinguishing between bilateral and unilateral disease is of fundamental importance because it allows targeted therapy. Adrenal vein sampling (AVS) is the only reliable means to preoperatively differentiate between unilateral and bilateral subtypes. A rare but serious complication of AVS is an adrenal hemorrhage (AH). We retrospectively examined in detail 24 cases of AH during AVS in 6 different referral hypertension centers. AH more often affected the right adrenal (n=18) than the left (n=5, P <0.001); 1 bilateral. Median duration of experience of the radiologist in AVS at the time of AH was 5.0 years (0.6–7.8) and AH occurred with both highly experienced (>10 years) and less experienced radiologists. Of 9 patients who suffered AH in the gland contralateral to an aldosterone-producing adenoma and who underwent complete (n=6) or partial (n=3) unilateral adrenalectomy, only one required long-term corticosteroid replacement for adrenal insufficiency. No reduction in blood pressure or biochemical resolution of primary aldosteronism occurred in any of those patients who experienced AH in the gland ipsilateral to an aldosterone-producing adenoma (n=6) or who had bilateral adrenal hyperplasia (n=9). No patient required invasive treatments to control bleeding or blood transfusion. In conclusion, AH usually has a positive outcome causing either no or minor effects on adrenal function, and AVS should remain the best approach to primary aldosteronism subtype differentiation.

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Section: Discussionmentioning

confidence: 99%

Clinical Management and Outcomes of Adrenal Hemorrhage Following Adrenal Vein Sampling in Primary Aldosteronism

et al. 2016

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“…The main disadvantages of this technique are that segmental AVS is technically even more demanding, time-consuming and expensive [53]. Furthermore, in two case series, an extravasation of the iodine contrast occurred in 12.6% [53] and in 16% [54] of patients undergoing segmental AVS, making this complication more common than in central AVS [53]. …”

Section: Segmental Avsmentioning

confidence: 99%

Subtype Diagnosis of Primary Aldosteronism: Is Adrenal Vein Sampling Always Necessary?

Buffolo

Monticone

Williams

et al. 2017

IJMS

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Aldosterone producing adenoma and bilateral adrenal hyperplasia are the two most common subtypes of primary aldosteronism (PA) that require targeted and distinct therapeutic approaches: unilateral adrenalectomy or lifelong medical therapy with mineralocorticoid receptor antagonists. According to the 2016 Endocrine Society Guideline, adrenal venous sampling (AVS) is the gold standard test to distinguish between unilateral and bilateral aldosterone overproduction and therefore, to safely refer patients with PA to surgery. Despite significant advances in the optimization of the AVS procedure and the interpretation of hormonal data, a standardized protocol across centers is still lacking. Alternative methods are sought to either localize an aldosterone producing adenoma or to predict the presence of unilateral disease and thereby substantially reduce the number of patients with PA who proceed to AVS. In this review, we summarize the recent advances in subtyping PA for the diagnosis of unilateral and bilateral disease. We focus on the developments in the AVS procedure, the interpretation criteria, and comparisons of the performance of AVS with the alternative methods that are currently available.

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“…In addition, S-AVS was performed after C-AVS in selected patients in a single session. Both C-AVS and S-AVS were performed by experienced interventional radiologists (K Seiji and K Takase), as reported previously (19). Briefly, 6.5 French (Fr) catheters were inserted via bilateral common femoral veins up to bilateral adrenal CV.…”

Section: C-avs and S-avsmentioning

confidence: 99%

“…In a previous report on the radiological aspects of S-AVS (19), 64 patients were enrolled and these patients were all included in the present study. One patient, excluded from that previous report (19) due to a history of unilateral adrenalectomy for unilateral APA, was also included in this study to evaluate the clinical significance of S-AVS in recurrent unilateral APA. Of the 322 patients originally selected, 297 participants were included.…”

Section: Subtype Analysis Based On C-avs and S-avsmentioning

confidence: 99%

Is there a role for segmental adrenal venous sampling and adrenal sparing surgery in patients with primary aldosteronism?

Satoh¹,

Morimoto²,

Seiji³

et al. 2015

European Journal of Endocrinology

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Objective and design: Adrenal venous sampling (AVS) is critical to determine the subtype of primary aldosteronism (PA). Central AVS (C-AVS) -that is, the collection of effluents from bilateral adrenal central veins (CV) -sometimes does not allow differentiation between bilateral aldosterone-producing adenomas (APA) and idiopathic hyperaldosteronism. To establish the best treatment course, we have developed segmental AVS (S-AVS); that is, we collect effluents from the tributaries of CV to determine the intra-adrenal sources of aldosterone overproduction. We then evaluated the clinical utility of this novel approach in the diagnosis and treatment of PA. Methods: We performed C-AVS and/or S-AVS in 297 PA patients and assessed the accuracy of diagnosis based on the results of C-AVS (nZ138, 46.5%) and S-AVS (nZ159, 53.5%) by comparison with those of clinicopathological evaluation of resected specimens.Results: S-AVS demonstrated both elevated and attenuated secretion of aldosterone from APA and non-tumorous segments, respectively, in patients with bilateral APA and recurrent APA. These findings were completely confirmed by detailed histopathological examination after surgery. S-AVS, but not C-AVS, also served to identify APA located distal from the CV. Conclusions: Compared to C-AVS, S-AVS served to identify APA in some patients, and its use should expand the pool of patients eligible for adrenal sparing surgery through the identification of unaffected segments, despite the fact that S-AVS requires more expertise and time. Especially, this new technique could enormously benefit patients with bilateral or recurrent APA because of the preservation of non-tumorous glandular tissue.

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Intra-adrenal Aldosterone Secretion: Segmental Adrenal Venous Sampling for Localization

Abstract: S-AVS could be used to identify heterogeneous intra-adrenal aldosterone secretion. Patients who have bilateral aldosterone-producing adenomas can be treated with adrenal-sparing surgery or other minimally invasive local therapies if any suppressed segment is identified at S-AVS.

Cited by 59 publications

References 26 publications

Clinical Management and Outcomes of Adrenal Hemorrhage Following Adrenal Vein Sampling in Primary Aldosteronism

Clinical Management and Outcomes of Adrenal Hemorrhage Following Adrenal Vein Sampling in Primary Aldosteronism

Subtype Diagnosis of Primary Aldosteronism: Is Adrenal Vein Sampling Always Necessary?

Is there a role for segmental adrenal venous sampling and adrenal sparing surgery in patients with primary aldosteronism?

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