Role for adrenal venous sampling in primary aldosteronism

Young, William F.; Stanson, Anthony W.; Thompson, Geoffrey B.; Grant, Clive S.; Farley, David R.; Heerden, Jon A. van

doi:10.1016/j.surg.2004.06.051

Cited by 636 publications

(659 citation statements)

References 20 publications

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“…The sensitivity and specificity of CT and MRI are Ͻ50% to 70%. [12][13][14][15][16] In a recent meta-analysis, CT, MRI, and AVS were re-evaluated in 950 patients from 38 studies. 17 In 38% of cases, CT and MRI gave incorrect diagnosis leading to a wrong decision.…”

Section: Discussionmentioning

confidence: 99%

“…Some authors defined a 10% higher cortisol value than in inferior vena cava, 14,18 -20 whereas others rely on higher indexes, such as 2, 3, or even 5. 7,15,17,[21][22][23][24][25] Accessory hepatic veins often drain together with the right adrenal vein into the inferior vena cava. Under these circumstances, adrenal blood with high cortisol values mixes with hepatic blood with a low cortisol value (lower than in the peripheral circulation because of hepatic metabolism of cortisol).…”

Section: Selective Catheterizationmentioning

confidence: 99%

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Adrenal Venous Sampling

et al. 2011

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Abstract-In patients with primary aldosteronism, adrenal venous sampling is helpful to distinguish between unilateral and bilateral adrenal diseases. However, the procedure is technically challenging, and selective bilateral catheterization often fails. The aim of this analysis was to evaluate success rate in a retrospective analysis and compare data with procedures done prospectively after introduction of measures designed to improve rates of successful cannulation. Patients were derived from a cross-sectional study involving 5 German centers (German Conn's registry Key Words: primary aldosteronism Ⅲ adrenal vein sampling Ⅲ aldosterone-producing adenoma Ⅲ bilateral idiopathic hyperaldosteronism Ⅲ rapid cortisol assay P rimary hyperaldosteronism (PA) is one of the common causes of secondary hypertension. 1,2 However, guidelines for screening, confirmatory testing, and procedures to differentiate between unilateral and bilateral disease are rare, 3 and cutoff parameters are not prospectively evaluated. More than 98% of patients with PA present with unilateral aldosteroneproducing adenoma (APA) or bilateral idiopathic hyperaldosteronism (IHA). In addition, there are monogenetic forms of PA. 4,5 However, therapy of the 2 subtypes APA and IHA differs substantially. Although hypertension attributed to unilateral APA can be cured surgically by adrenalectomy, IHA is treated by mineralocorticoid receptor antagonists.

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Section: Discussionmentioning

confidence: 99%

Section: Selective Catheterizationmentioning

confidence: 99%

Adrenal Venous Sampling

et al. 2011

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“…Adrenocortical hormones are under the effect of ACTH, and AVS without sufficient pre-stimulation could be affected by its fluctuation (4)(5)(6). Therefore, some investigators advocated pre-stimulation with synthetic corticotropin to ensure active adrenal secretion at the time of AVS (7)(8)(9)(10). However, others expressed concern that the prestimulation could abolish the laterality of aldosterone secretion (11); the dose of synthetic corticotropin generally used for the pre-stimulation is extra-physiologically high (12,13), and the exaggerated corticotropic response by it could conceal the laterality.…”

Section: Introductionmentioning

confidence: 99%

Physiologic variance of corticotropin affects diagnosis in adrenal vein sampling

Tanemoto

Suzuki²,

Abe³

et al. 2009

European Journal of Endocrinology

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Objective: Differentiating unilateral form from bilateral is a critical diagnostic step in primary aldosteronism (PA), for which adrenal vein sampling (AVS) is accepted to be the most reliable. However, variance of corticotropin could affect the diagnosis in AVS. Design and methods: We conducted simultaneous bilateral AVS on ten biochemically diagnosed PA cases, and used the aldosterone-to-cortisol ratio (A/C) of the samples for the diagnosis. The diagnosis by AVS after a low-dose (0.1 mg) ACTH stimulation, which can provoke maximum-physiologic corticotropic response, was compared with those before the stimulation and after the standard-dose (250 mg) ACTH stimulation. Results: In half of the cases, the low-dose pre-stimulation affected the diagnosis. In four out of ten cases, the side-to-side ratios of A/C were changed in the basal/low-dose/standard-dose AVS as 6.62/2.46/0.63, 2.13/0.41/0.14, 1.88/2.38/2.40, and 1.96/2.27/1.90 respectively. In three out of ten cases, the adrenal vein to the matching inferior vena cava ratio of A/C was also changed across 1, the cut-off to indicate suppression of aldosterone secretion. Additionally, the confirmation of successful sampling was difficult in five out of ten and two out of ten cases of the basal and low-dose AVS respectively, whereas it was easy in all the cases of the standard-dose AVS. Conclusions: The diagnosis in the basal AVS could be affected by the physiologic fluctuation of ACTH at relatively high prevalence. The basal AVS would be unreliable to differentiate two forms of PA.

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“…To minimize the impact of these factors, ACTH infusion was introduced by Weinberger et al (22) and widely used thereafter (21,23,24), thus being held as an essential part of the sequential AVS (11,19,21,25), or even of bilaterally simultaneous AVS (5,26,27). In our hands, cosyntropin stimulation confounded the assessment of lateralization and led to misclassification of the APA side (8,17).…”

Section: Impact Of Sequential or Simultaneous Avs On Si Valuementioning

confidence: 80%

A stress reaction affects assessment of selectivity of adrenal venous sampling and of lateralization of aldosterone excess in primary aldosteronism

Seccia

Miotto²,

Battistel³

et al. 2012

European Journal of Endocrinology

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Background: A stress reaction involving increased cortisol release, which has not been documented thus far, might affect the assessment of selectivity of catheterization during adrenal venous sampling (AVS). Objective: To investigate whether an ACTH-driven cortisol release occurs during AVS and whether it influences the assessment of selectivity by the step-up of cortisol (plasma cortisol concentrations, PCC) between the adrenal vein blood (PCC SIDE ) and the inferior vena cava (PCC IVC ), e.g. the selectivity index (SI). Design and methods: We determined the SI in samples obtained simultaneously at starting AVS (t-15) and again after 15 min (t0) in 34 consecutive patients with proven aldosterone-producing adenoma. We then calculated the SI with PCC SIDE obtained at t-15 and at t0, and the PCC IVC values obtained at the different time point, thus simulating sequential AVS. Results: The PCC SIDE and the SI fell significantly from t-15 to t0 on both the sides. When PCC SIDE obtained at t-15 was combined with PCC IVC at t0, the SI values were higher than those obtained with simultaneously drawn samples. This led to label as selective more AVS studies than with bilaterally simultaneous data, especially when using higher cutoffs for the SI. Conclusions: A transient increase in cortisol release from both adrenal glands occurs in the majority of the patients who undergo AVS. This stress reaction can influence the assessment of both the selectivity of the catheterization during the sequential AVS technique and the lateralization of aldosterone excess.

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Role for adrenal venous sampling in primary aldosteronism

Cited by 636 publications

References 20 publications

Adrenal Venous Sampling

Adrenal Venous Sampling

Physiologic variance of corticotropin affects diagnosis in adrenal vein sampling

A stress reaction affects assessment of selectivity of adrenal venous sampling and of lateralization of aldosterone excess in primary aldosteronism

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