The role of adrenal venous sampling in the surgical management of primary aldosteronism.
OBJECTIVE
Primary aldosteronism is the most common endocrine form of secondary hypertension, but no single test or imaging method always identifies it. Identification of a unilateral overproduction of aldosterone due to Conn's adenoma or unilateral hyperplasia is of utmost importance to the surgeon.


METHODS
We reviewed our experience with primary aldosteronism in 46 consecutive patients who had undergone adrenalectomy at the Surgical Pathology Institute, University of Padua since 1993. All the patients underwent a CT scan. Adrenal venous sampling was performed in those patients with negative or equivocal findings on imaging studies.


RESULTS
Computed tomography was non-contributory in 12 patients and frankly misleading in 2 patients, demonstrating a probable mass lesion in the contralateral but not in the ipsilateral adrenal. Eighteen patients had selective venous sampling that was successful in altering the management of 14 cases. Eleven patients who biochemically had an adrenal adenoma, had normal/equivocal CT, while the remaining 3 had bilateral or contralateral adrenal masses. Venous sampling localized aldosterone secretion and an adenoma, less than 1 cm in diameter, was removed, curing their hypertension. Eleven patients were treated by open adrenalectomy and 35 by the lateral transperitoneal laparoscopic approach. Histological examination revealed 45 Conn's adenomas, of which 13 had a diameter of less than 1 cm (range 0.3-0.8), and 1 case of nodular hyperplasia.


CONCLUSIONS
Patients who have equivocal or unexpected CT findings should proceed to hormonal localization. Adrenal venous sampling is essential in patients with equivocal CT scans to avoid unnecessary and inappropriate adrenalectomy.
Toniato
Antonio
A
Department of Medical Surgical Sciences, School of Medicine, University of Padua, Padua 35128, Italy. giorgiolina@libero.it
Bernante
Paolo
P
Rossi
Gian Paolo
GP
Pelizzo
Maria Rosa
MR
D000306:Adrenal Cortex Neoplasms / Q000097:blood / Q000601:surgery*; D000311:Adrenal Glands / Q000098:blood supply* / Q000473:pathology; D000315:Adrenalectomy; D018246:Adrenocortical Adenoma / Q000097:blood / Q000601:surgery*; D000308:Adrenocortical Hyperfunction / Q000097:blood / Q000601:surgery*; D000328:Adult; D000368:Aged; D000450:Aldosterone / Q000097:blood*; D005260:Female; D006801:Humans; D006929:Hyperaldosteronism / Q000097:blood / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D012016:Reference Values; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed; D014680:Veins
D000450:Aldosterone