title: Is adrenal venous sampling necessary in all patients with hyperaldosteronism before adrenalectomy?
abstract: 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.
authors.affiliation: Department of Surgery, University of California San Francisco Medical Center, San Francisco, CA, USA.
authors.forename: Rasa
authors.initials: R
authors.lastname: Zarnegar
authors.forename: Alan I
authors.initials: AI
authors.lastname: Bloom
authors.forename: James
authors.initials: J
authors.lastname: Lee
authors.forename: Robert K
authors.initials: RK
authors.lastname: Kerlan
authors.forename: Mark W
authors.initials: MW
authors.lastname: Wilson
authors.forename: Jeanne M
authors.initials: JM
authors.lastname: Laberge
authors.forename: Roy L
authors.initials: RL
authors.lastname: Gordon
authors.forename: Electron
authors.initials: E
authors.lastname: Kebebew
authors.forename: Orlo H
authors.initials: OH
authors.lastname: Clark
authors.forename: Quan-Yang
authors.initials: QY
authors.lastname: Duh
mesh_terms: 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
chemical_list: D000959:Antihypertensive Agents; D015415:Biomarkers; D000450:Aldosterone; D011188:Potassium; D006854:Hydrocortisone