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Lee, Kang, Kim, Shin, Kim, and Chung: The Clinical Implication and Problems of Adrenal Vein Sampling in Patients with Primary Aldosteronism
Original Article
Journal of Korean Endocrine Society

Journal of Korean Endocrine Society 2007; 22(6): 428-435.

Published online: 20 December 2007

DOI: https://doi.org/10.3803/jkes.2007.22.6.428

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

Jie Seon Lee, Mi Yeon Kang, Sang Wan Kim, Chan Soo Shin, Seong Yeon Kim, Jin-Wook Chung, 1

Department of Internal Medicine, Seoul National University College of Medicine, Korea.

1Department of Radiology, Seoul National University College of Medicine, Korea.

Received 10 August 2007       Accepted 26 October 2007

Copyright © 2007 Korean Endocrine Society

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.

Keywords: adrenal vein sampling, primary aldosteronism

Figures and Tables

Table 1
Baseline characteristics
jkes-22-428-i001

PRA, plama renin activity; PAC, plasma aldosterone; APA, aldosterone producing adenoma; BAH, bilateral adrenal hyperplasia; SBP, systolic blood pressure; DBP, diastolic blood pressure.

Table 2
Incidence of hypertensive complications in patients with primary aldosteronism
jkes-22-428-i002
Table 3
APA vs BAH according to adrenal vein sampling
jkes-22-428-i003

APA, aldosterone-producing adenoma; BAH, bilateral adrenal hyperplasia; PRA, plasma renin activity; PAC, plasma aldosterone; SBP, systolic blood pressure; DBP, diastolic blood pressure.

Table 4
Laboratory results and abdominal CT findings of patients who had undergone selective adrenal vein sampling
jkes-22-428-i004

*adrenalectomy was not done.

‡cosyntropin mixed fluid was not infused.

Table 5
The Results of adrenal vein sampling and abdominal CT findings of patients who had not undergone selective adrenal vein sampling
jkes-22-428-i005

*adrenalectomy was not done.

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