title: Optimum position of left adrenal vein sampling for subtype diagnosis in primary aldosteronism.
abstract: BACKGROUND
  Although adrenal vein sampling (AVS) is the standard method for subtype diagnosis in primary aldosteronism (PA), protocol details including the sampling position in the adrenal vein are not standardized.
  
  
  OBJECTIVE
  To establish the optimum sampling position in the left adrenal vein based on postoperative outcome in PA patients.
  
  
  METHODS
  Retrospective study in nine referral centres.
  
  
  METHODS
  Of 496 consecutive PA patients who underwent AVS between 2006 and 2013, 217 with successful AVS under cosyntropin stimulation, and with concomitant data from two positions: proximal (common trunk) and distal (central vein) to the junction with the inferior phrenic vein, were included.
  
  
  METHODS
  Discordant rate of subtype diagnosis between common trunk and central vein, and postoperative outcomes in patients with discordant results.
  
  
  RESULTS
  Subtype diagnosis using common trunk and central vein was discordant in 10 (4·6%) of the 217 patients (κ = 0·87, P < 0·05). Of these 10 patients, eight with left unilateral subtype and two with bilateral subtype using common trunk data showed bilateral subtype and unilateral subtype, respectively, using central vein data. Five patients with left unilateral subtype and one with bilateral subtype by common trunk data underwent unilateral adrenalectomy. All six patients were cured of PA after adrenalectomy, resulting in false-negative rates of 17% (1/6) by common trunk data, and 83% (5/6) by central vein data.
  
  
  CONCLUSIONS
  In view of its better potential diagnostic accuracy, technical ease, lower cost and lower risk of vein rupture, blood sampling from the common trunk of the left adrenal vein may be preferable as the standard method of AVS in patients with PA, although additional studies in a larger number of cases are required.
authors.affiliation: Department of Endocrinology, Metabolism, and Hypertension, Clinical Research Institute, National Hospital Organisation Kyoto Medical Centre, Kyoto, Japan.
authors.forename: Hironobu
authors.initials: H
authors.lastname: Umakoshi
authors.affiliation: Department of Diabetes and Endocrinology, Sapporo City Hospital, Sapporo, Japan.
authors.forename: Norio
authors.initials: N
authors.lastname: Wada
authors.affiliation: Department of Diabetes and Endocrinology, Saiseikai Yokohama City Toubu Hospital, Yokohama, Japan.
authors.forename: Takamasa
authors.initials: T
authors.lastname: Ichijo
authors.affiliation: Department of Cardiology, Akashi Medical Centre, Akashi, Japan.
authors.forename: Kohei
authors.initials: K
authors.lastname: Kamemura
authors.affiliation: Department of Cardiology, Sanda City Hospital, Sanda, Japan.
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Matsuda
authors.affiliation: Department of Cardiology, Hiroshima General Hospital of West Japan Railway Company, Hiroshima, Japan.
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Fuji
authors.affiliation: Department of Cardiology, Saiseikai Tondabayashi Hospital, Tondabayashi, Japan.
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Kai
authors.affiliation: Department of Internal Medicine, Matsuyama Red Cross Hospital, Matsuyama, Japan.
authors.forename: Tomikazu
authors.initials: T
authors.lastname: Fukuoka
authors.affiliation: Department of Endocrinology and Metabolism, National Hospital Organisation, Kyushu Medical Centre, Fukuoka, Japan.
authors.forename: Ryuichi
authors.initials: R
authors.lastname: Sakamoto
authors.affiliation: Department of Endocrinology and Metabolism, National Hospital Organisation, Kyushu Medical Centre, Fukuoka, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Ogo
authors.affiliation: Department of Public Health, Kitasato University School of Medicine, Tokyo, Japan.
authors.forename: Tomoko
authors.initials: T
authors.lastname: Suzuki
authors.affiliation: Department of Endocrinology, Metabolism, and Hypertension, Clinical Research Institute, National Hospital Organisation Kyoto Medical Centre, Kyoto, Japan.
authors.forename: Mika
authors.initials: M
authors.lastname: Tsuiki
authors.affiliation: Department of Endocrinology, Metabolism, and Hypertension, Clinical Research Institute, National Hospital Organisation Kyoto Medical Centre, Kyoto, Japan.
authors.forename: Mitsuhide
authors.initials: M
authors.lastname: Naruse
mesh_terms: D000311:Adrenal Glands / Q000098:blood supply* / Q000473:pathology; D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D006929:Hyperaldosteronism / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014680:Veins