Is adrenal venous sampling necessary in all patients with hyperaldosteronism before adrenalectomy?
OBJECTIVE
To evaluate whether selective rather than universal use of adrenal vein sampling (AVS) may be warranted in patients with hyperaldosteronism to characterize and lateralize disease before adrenalectomy.


METHODS
Fifty-nine consecutive patients with biochemically diagnosed hyperaldosteronism underwent unilateral adrenalectomy at a single center during a 10-year period. In one group (n = 30), adrenalectomy was based on computed tomography (CT) only; in another (n = 29), it was based on CT and AVS. The indication for AVS was equivocal CT finding (n = 26) or patient request (n = 3). Outcome variables were postoperative serum potassium and aldosterone levels, number of hypertensive medications, and mean arterial blood pressure at 6 months.


RESULTS
Preoperatively, both groups were matched for age, years of hypertension, mean arterial blood pressure, and number of hypertensive medications. Average tumor sizes were 2 cm (range, 1-3 cm) in the CT-only group and 1 cm (range, 0-2.5 cm) in the CT/AVS group. Unilateral tumor was identified on CT in 30 patients (100%) in the CT-only group and in 17 patients (59%) in the CT/AVS group (P < .05). Postoperatively, aldosterone levels were lower in the CT-only group (6.3 ng/dL +/- 5.9 vs 13.5 ng/dL +/- 16; P < .05). Both groups had similar improvements in mean arterial blood pressure at 6 months (92 mm Hg +/- 12 vs 96 mm Hg +/- 9; P = .14), reductions in number of hypertensive medications (to 1.1 +/- 1.3 vs 1.2 +/- 1.1; P = .4), and improvements in hypokalemia (3.8 mEq/L +/- 0.5 vs 3.8 mEq/L +/- 0.5; P = .5).


CONCLUSIONS
The clinical impact of adrenalectomy was similar in both groups. CT can be used to reliably diagnose adenomas larger than 1.0 cm. AVS should be used when CT findings are equivocal or both adrenal glands are abnormal.
Zarnegar
Rasa
R
Department of Surgery, University of California San Francisco Medical Center, San Francisco, CA, USA.
Bloom
Alan I
AI
Lee
James
J
Kerlan
Robert K
RK
Wilson
Mark W
MW
Laberge
Jeanne M
JM
Gordon
Roy L
RL
Kebebew
Electron
E
Clark
Orlo H
OH
Duh
Quan-Yang
QY
D000236:Adenoma / Q000097:blood* / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D000310:Adrenal Gland Neoplasms / Q000097:blood* / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D000311:Adrenal Glands / Q000098:blood supply* / Q000000981:diagnostic imaging / Q000378:metabolism / Q000601:surgery; D000315:Adrenalectomy; D000328:Adult; D000450:Aldosterone / Q000097:blood*; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D015415:Biomarkers / Q000097:blood; D001794:Blood Pressure; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D006929:Hyperaldosteronism / Q000097:blood / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011188:Potassium / Q000097:blood; D011237:Predictive Value of Tests; D011300:Preoperative Care; D015203:Reproducibility of Results; D012189:Retrospective Studies; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014680:Veins
D000959:Antihypertensive Agents; D015415:Biomarkers; D000450:Aldosterone; D011188:Potassium; D006854:Hydrocortisone