title: Consequences of adrenal venous sampling in primary hyperaldosteronism and predictors of unilateral adrenal disease.
abstract: BACKGROUND
  In patients with primary hyperaldosteronism, distinguishing between unilateral and bilateral adrenal hypersecretion is critical in assessing treatment options. Adrenal venous sampling (AVS) has been advocated by some to be the gold standard for localization of the responsible lesion, but there remains a lack of consensus for the criteria and the standardization of technique.
  
  
  METHODS
  We performed a retrospective study of 114 patients with a biochemical diagnosis of primary hyperaldosteronism who all underwent CT scan and AVS before and after corticotropin (ACTH) stimulation. Univariate and multivariate analyses were performed to determine what factors were associated with AVS lateralization, and which AVS values were the most accurate criteria for lateralization.
  
  
  RESULTS
  Eighty-five patients underwent surgery at our institution for unilateral hyperaldosteronism. Of the 57 patients who demonstrated unilateral abnormalities on CT, AVS localized to the contralateral side in 5 patients and revealed bilateral hyperplasia in 6 patients. Of the 52 patients who showed bilateral disease on CT scan, 43 lateralized with AVS. The most accurate criterion on AVS for lateralization was the post-ACTH stimulation value. Factors associated with AVS lateralization included a low renin value, high plasma aldosterone-to plasma-renin ratio, and adrenal mass > or = 3 cm on CT scan.
  
  
  CONCLUSIONS
  Because 50% of patients would have been inappropriately managed based on CT scan findings, patients with biochemical evidence of primary hyperaldosteronism and considering adrenalectomy should have AVS. The most accurate measurement for AVS lateralization was the post-ACTH stimulation value. Although several factors predict successful AVS lateralization, none are accurate enough to perform AVS selectively.
authors.affiliation: Endocrine Oncology Section, Surgery Branch, National Cancer Institute, MD, USA.
authors.forename: Aarti
authors.initials: A
authors.lastname: Mathur
authors.forename: Clinton D
authors.initials: CD
authors.lastname: Kemp
authors.forename: Utpal
authors.initials: U
authors.lastname: Dutta
authors.forename: Smita
authors.initials: S
authors.lastname: Baid
authors.forename: Alejandro
authors.initials: A
authors.lastname: Ayala
authors.forename: Richard E
authors.initials: RE
authors.lastname: Chang
authors.forename: Seth M
authors.initials: SM
authors.lastname: Steinberg
authors.forename: Vasilios
authors.initials: V
authors.lastname: Papademetriou
authors.forename: Eileen
authors.initials: E
authors.lastname: Lange
authors.forename: Steven K
authors.initials: SK
authors.lastname: Libutti
authors.forename: James F
authors.initials: JF
authors.lastname: Pingpank
authors.forename: H Richard
authors.initials: HR
authors.lastname: Alexander
authors.forename: Giao Q
authors.initials: GQ
authors.lastname: Phan
authors.forename: Marybeth
authors.initials: M
authors.lastname: Hughes
authors.forename: W Marston
authors.initials: WM
authors.lastname: Linehan
authors.forename: Peter A
authors.initials: PA
authors.lastname: Pinto
authors.forename: Constantine A
authors.initials: CA
authors.lastname: Stratakis
authors.forename: Electron
authors.initials: E
authors.lastname: Kebebew
mesh_terms: D000307:Adrenal Gland Diseases / Q000097:blood* / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging; D000310:Adrenal Gland Neoplasms / Q000097:blood / Q000175:diagnosis; D000311:Adrenal Glands / Q000098:blood supply* / Q000000981:diagnostic imaging / Q000378:metabolism* / Q000473:pathology; D000315:Adrenalectomy; D000324:Adrenocorticotropic Hormone; D000328:Adult; D000368:Aged; D000450:Aldosterone / Q000097:blood; D015415:Biomarkers / Q000097:blood; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D006929:Hyperaldosteronism / Q000097:blood* / Q000175:diagnosis* / Q000000981:diagnostic imaging; D006965:Hyperplasia / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D012083:Renin / Q000097:blood; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D014680:Veins
chemical_list: D015415:Biomarkers; D000450:Aldosterone; D000324:Adrenocorticotropic Hormone; D012083:Renin; D006854:Hydrocortisone
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