Adrenal venous sampling: where is the aldosterone disappearing to?
Adrenal venous sampling (AVS) is generally considered to be the gold standard in distinguishing unilateral and bilateral aldosterone hypersecretion in primary hyperaldosteronism. However, during AVS, we noticed a considerable variability in aldosterone concentrations among samples thought to have come from the right adrenal glands. Some aldosterone concentrations in these samples were even lower than in samples from the inferior vena cava. We hypothesized that the samples with low aldosterone levels were unintentionally taken not from the right adrenal gland, but from hepatic veins. Therefore, we sought to analyze the impact of unintentional cannulation of hepatic veins on AVS. Thirty consecutive patients referred for AVS were enrolled. Hepatic vein sampling was implemented in our standardized AVS protocol. The data were collected and analyzed prospectively. AVS was successful in 27 patients (90%), and hepatic vein cannulation was successful in all procedures performed. Cortisol concentrations were not significantly different between the hepatic vein and inferior vena cava samples, but aldosterone concentrations from hepatic venous blood (median, 17 pmol/l; range, 40-860 pmol/l) were markedly lower than in samples from the inferior vena cava (median, 860 pmol/l; range, 460-4510 pmol/l). The observed difference was statistically significant (P < 0.001). Aldosterone concentrations in the hepatic veins are significantly lower than in venous blood taken from the inferior vena cava. This finding is important for AVS because hepatic veins can easily be mistaken for adrenal veins as a result of their close anatomic proximity.
Department of Internal Medicine, Charles University Prague, Medical Faculty Hradec Kralove, University Hospital Hradec Kralove, Sokolska 581, 500 05 Hradec Kralove, Czech Republic.
Miroslav
M
Solar
Jiri
J
Ceral
Antonin
A
Krajina
Marek
M
Ballon
Eva
E
Malirova
Milos
M
Brodak
Jan
J
Cap
D000311:Adrenal Glands / Q000098:blood supply*; D000328:Adult; D000368:Aged; D000450:Aldosterone / Q000097:blood*; D003937:Diagnosis, Differential; D005260:Female; D006503:Hepatic Veins / Q000378:metabolism*; D006801:Humans; D006929:Hyperaldosteronism / Q000097:blood* / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D014682:Vena Cava, Inferior / Q000378:metabolism
D000450:Aldosterone