Value of adrenal venous sampling for lesion localization in primary aldosteronism.
BACKGROUND
Distinguishing between unilateral and bilateral adrenal lesions is mandatory for surgical treatment of primary aldosteronism (PA). Adrenal venous sampling (AVS) is considered the gold standard for identification and localization of the lesion or lesions causing PA. The objective of the present study was to determine the usefulness of AVS in PA patients.


METHODS
From January 2001 to October 2011, 86 patients with the biochemical diagnosis of PA were retrospectively analyzed. The study group included 45 males and 41 females with a mean age of 50.7 ± 12.6 years, and all patients underwent adrenal computed tomography (CT) and AVS.


RESULTS
The catheterization success rate of AVS was 82.69 % (86/104). In addition, AVS revealed bilateral lesions in 15/75 patients with unilateral abnormalities diagnosed by CT. These patients underwent medical treatment instead of surgery. One patient had an adrenal mass on the right side, but AVS localized the lesion on the left side. This patient underwent left adrenalectomy. Furthermore, AVS revealed a unilateral lesion in 2/5 patients with bilateral abnormalities demonstrated by CT. These patients underwent unilateral adrenalectomy. Finally, AVS demonstrated localization in 1/6 of patients with no CT abnormalities who were subjected to surgery. Fifty-three patients with unilateral lesion and one patient with bilateral hypersecretion underwent surgical removal of the affected gland(s). All patients had resolution of hypokalemia and clinical improvement of hypertension.


CONCLUSIONS
Many patients (19/86, or 22.09 %) would have been inappropriately managed if decision making had been based solely on CT findings. Therefore, AVS is recommended before determining definitive PA management.
Department of Surgery, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Republic of Korea. 2627042@naver.com
Eun Mee
EM
Oh
Kyu Eun
KE
Lee
Kwan
K
Yoon
Seong Yeon
SY
Kim
Hyo-Cheol
HC
Kim
Yeo-Kyu
YK
Youn
D000311:Adrenal Glands / Q000098:blood supply; D000328:Adult; D000368:Aged; D001800:Blood Specimen Collection / Q000379:methods; D005260:Female; D006403:Hematologic Tests / Q000379:methods; D006801:Humans; D006929:Hyperaldosteronism / Q000097:blood* / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D014680:Veins; D055815:Young Adult