title: Adrenal venous sampling for stratifying patients for surgery of adrenal nodules detected using dynamic contrast enhanced CT.
abstract: OBJECTIVE
  We aimed to assess the value of adrenal venous sampling (AVS) for diagnosing primary aldosteronism (PA) subtypes in patients with a unilateral nodule detected on adrenal computed tomography (CT) and scheduled for adrenalectomy.
  
  
  METHODS
  This retrospective study included 80 consecutive patients with PA undergoing CT and AVS. Different lateralization indices were assessed, and a cutoff established using receiver operating characteristic curve analysis. The value of CT alone versus CT with AVS for differentiating PA subtypes was compared. The adrenalectomy outcome was assessed, and predictors of cure were determined using univariate analysis.
  
  
  RESULTS
  AVS was successful in 68 patients. A cortisol-corrected aldosterone affected-to-unaffected ratio cutoff of 2.0 and affected-to-inferior vena cava ratio cutoff of 1.4 were the best lateralization indices, with accuracies of 82.5% and 80.4%, respectively. CT and AVS diagnosed 38 patients with aldosterone-producing adenomas, five patients with unilateral adrenal hyperplasia, and 25 patients with bilateral adrenal hyperplasia. Of the 52 patients with a nodule detected on CT, subsequent AVS diagnosed bilateral adrenal hyperplasia in 14 patients (27%). Compared to the results of combining CT with AVS, the accuracy of CT alone for diagnosing aldosterone-producing adenomas was 71.1% (P < 0.001). The cure rate for hypertension after adrenalectomy was 39.2%, with improvement in 53.5% of patients. On univariate analysis, predictors of persistent hypertension were male gender and preoperative systolic blood pressure.
  
  
  CONCLUSIONS
  To avoid inappropriate surgery, AVS is necessary for diagnosing unilateral nodules with aldosterone hypersecretion detected by CT.
authors.affiliation: From the Department of Radiology (J.Y.K. e-mail: kseehdr@dsmc.or.kr, S.H.K., H.J.L., Y.H.K., M.J.K.), Dongsan Hospital, Keimyung University College of Medicine, Daegu, Republic of Korea; the Department of Radiology (S.H.C.), Kyungpook National University School of Medicine, Daegu, Republic of Korea.
authors.forename: Jin Young
authors.initials: JY
authors.lastname: Kim
authors.forename: See Hyung
authors.initials: SH
authors.lastname: Kim
authors.forename: Hee Jung
authors.initials: HJ
authors.lastname: Lee
authors.forename: Young Hwan
authors.initials: YH
authors.lastname: Kim
authors.forename: Mi Jeong
authors.initials: MJ
authors.lastname: Kim
authors.forename: Seung Hyun
authors.initials: SH
authors.lastname: Cho
mesh_terms: D000311:Adrenal Glands / Q000000981:diagnostic imaging / Q000473:pathology; D000315:Adrenalectomy; D000328:Adult; D005260:Female; D006801:Humans; D006929:Hyperaldosteronism / Q000097:blood* / Q000145:classification / Q000000981:diagnostic imaging* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed
references.citation: Hypertension. 2009 May;53(5):761-6
references.pmid: 19349554
references.citation: J Hum Hypertens. 2000 May;14(5):311-5
references.pmid: 10822317
references.citation: Hypertension. 2008 May;51(5):1366-71
references.pmid: 18347224
references.citation: AJR Am J Roentgenol. 2000 Nov;175(5):1411-5
references.pmid: 11044054
references.citation: J Clin Endocrinol Metab. 2008 Sep;93(9):3266-81
references.pmid: 18552288
references.citation: Radiology. 2002 Mar;222(3):629-33
references.pmid: 11867777
references.citation: Clin Endocrinol (Oxf). 2009 Jan;70(1):14-7
references.pmid: 19128364
references.citation: J Clin Endocrinol Metab. 2006 Jul;91(7):2618-23
references.pmid: 16670162
references.citation: Ann Intern Med. 2009 Sep 1;151(5):329-37
references.pmid: 19721021
references.citation: J Hypertens. 2003 Nov;21(11):2149-57
references.pmid: 14597859
references.citation: Ann Surg. 1980 Jan;191(1):1-7
references.pmid: 7352772
references.citation: Ann Surg. 2008 Mar;247(3):511-8
references.pmid: 18376197
references.citation: Am J Hypertens. 1990 Jul;3(7):576-82
references.pmid: 2194512
references.citation: J Clin Endocrinol Metab. 2000 Aug;85(8):2854-9
references.pmid: 10946893
references.citation: Lancet. 1999 Jan 2;353(9146):40
references.pmid: 10023956
references.citation: J Hypertens. 2008 May;26(5):989-97
references.pmid: 18398342
references.citation: QJM. 1999 Nov;92(11):643-50
references.pmid: 10542304
references.citation: J Am Coll Surg. 2010 Sep;211(3):384-90
references.pmid: 20800196
references.citation: J Clin Endocrinol Metab. 2001 Mar;86(3):1083-90
references.pmid: 11238490
references.citation: J Clin Endocrinol Metab. 2005 Jan;90(1):72-8
references.pmid: 15483077
references.citation: J Hypertens. 2008 Apr;26(4):613-21
references.pmid: 18327065
references.citation: Surgery. 2004 Dec;136(6):1227-35
references.pmid: 15657580
references.citation: J Am Coll Cardiol. 2006 Dec 5;48(11):2293-300
references.pmid: 17161262
references.citation: J Clin Endocrinol Metab. 2001 Mar;86(3):1066-71
references.pmid: 11238487
references.citation: J Clin Endocrinol Metab. 2008 Apr;93(4):1366-71
references.pmid: 18198224
references.citation: J Vasc Interv Radiol. 2008 Jan;19(1):66-71
references.pmid: 18192469
references.citation: Hypertension. 2011 May;57(5):990-5
references.pmid: 21383311
references.citation: Hypertension. 2010 Mar;55(3):667-73
references.pmid: 20124107
references.citation: Circulation. 2002 Sep 17;106(12):1572-85
references.pmid: 12234967
references.citation: Surgery. 2006 Dec;140(6):847-53; discussion 853-5
references.pmid: 17188130