title: Intra-adrenal Aldosterone Secretion: Segmental Adrenal Venous Sampling for Localization.
abstract: OBJECTIVE
  To use segmental adrenal venous sampling (AVS) (S-AVS) of effluent tributaries (a version of AVS that, in addition to helping identify aldosterone hypersecretion, also enables the evaluation of intra-adrenal hormone distribution) to detect and localize intra-adrenal aldosterone secretion.
  
  
  METHODS
  The institutional review board approved this study, and all patients provided informed consent. S-AVS was performed in 65 patients with primary aldosteronism (34 men; mean age, 50.9 years ± 11 [standard deviation]). A microcatheter was inserted in first-degree tributary veins. Unilateral aldosterone hypersecretion at the adrenal central vein was determined according to the lateralization index after cosyntropin stimulation. Excess aldosterone secretion at the adrenal tributary vein was considered to be present when the aldosterone/cortisol ratio from this vein exceeded that from the external iliac vein; suppressed secretion was indicated by the opposite pattern. Categoric variables were expressed as numbers and percentages; continuous variables were expressed as means ± standard errors of the mean.
  
  
  RESULTS
  The AVS success rate, indicated by a selectivity index of 5 or greater, was 98% (64 of 65). The mean numbers of sampled tributaries on the left and right sides were 2.11 and 1.02, respectively. The following diagnoses were made on the basis of S-AVS results: unilateral aldosterone hypersecretion in 30 patients, bilateral hypersecretion without suppressed segments in 22 patients, and bilateral hypersecretion with at least one suppressed segment in 12 patients. None of the patients experienced severe complications.
  
  
  CONCLUSIONS
  S-AVS could be used to identify heterogeneous intra-adrenal aldosterone secretion. Patients who have bilateral aldosterone-producing adenomas can be treated with adrenal-sparing surgery or other minimally invasive local therapies if any suppressed segment is identified at S-AVS.
authors.affiliation: From the Department of Diagnostic Radiology (N.S., H.O., K.S., K.T.) and Division of Nephrology, Endocrinology, and Vascular Medicine, Department of Medicine (R.M., M.K., Y.I., Y.O., M.N., K.O., S.I., F.S.), Tohoku University Hospital, 1-1 Seiryo, Aoba, Sendai 980-8574, Japan.
authors.forename: Nozomi
authors.initials: N
authors.lastname: Satani
authors.affiliation: From the Department of Diagnostic Radiology (N.S., H.O., K.S., K.T.) and Division of Nephrology, Endocrinology, and Vascular Medicine, Department of Medicine (R.M., M.K., Y.I., Y.O., M.N., K.O., S.I., F.S.), Tohoku University Hospital, 1-1 Seiryo, Aoba, Sendai 980-8574, Japan.
authors.forename: Hideki
authors.initials: H
authors.lastname: Ota
authors.affiliation: From the Department of Diagnostic Radiology (N.S., H.O., K.S., K.T.) and Division of Nephrology, Endocrinology, and Vascular Medicine, Department of Medicine (R.M., M.K., Y.I., Y.O., M.N., K.O., S.I., F.S.), Tohoku University Hospital, 1-1 Seiryo, Aoba, Sendai 980-8574, Japan.
authors.forename: Kazumasa
authors.initials: K
authors.lastname: Seiji
authors.affiliation: From the Department of Diagnostic Radiology (N.S., H.O., K.S., K.T.) and Division of Nephrology, Endocrinology, and Vascular Medicine, Department of Medicine (R.M., M.K., Y.I., Y.O., M.N., K.O., S.I., F.S.), Tohoku University Hospital, 1-1 Seiryo, Aoba, Sendai 980-8574, Japan.
authors.forename: Ryo
authors.initials: R
authors.lastname: Morimoto
authors.affiliation: From the Department of Diagnostic Radiology (N.S., H.O., K.S., K.T.) and Division of Nephrology, Endocrinology, and Vascular Medicine, Department of Medicine (R.M., M.K., Y.I., Y.O., M.N., K.O., S.I., F.S.), Tohoku University Hospital, 1-1 Seiryo, Aoba, Sendai 980-8574, Japan.
authors.forename: Masataka
authors.initials: M
authors.lastname: Kudo
authors.affiliation: From the Department of Diagnostic Radiology (N.S., H.O., K.S., K.T.) and Division of Nephrology, Endocrinology, and Vascular Medicine, Department of Medicine (R.M., M.K., Y.I., Y.O., M.N., K.O., S.I., F.S.), Tohoku University Hospital, 1-1 Seiryo, Aoba, Sendai 980-8574, Japan.
authors.forename: Yoshitsugu
authors.initials: Y
authors.lastname: Iwakura
authors.affiliation: From the Department of Diagnostic Radiology (N.S., H.O., K.S., K.T.) and Division of Nephrology, Endocrinology, and Vascular Medicine, Department of Medicine (R.M., M.K., Y.I., Y.O., M.N., K.O., S.I., F.S.), Tohoku University Hospital, 1-1 Seiryo, Aoba, Sendai 980-8574, Japan.
authors.forename: Yoshikiyo
authors.initials: Y
authors.lastname: Ono
authors.affiliation: From the Department of Diagnostic Radiology (N.S., H.O., K.S., K.T.) and Division of Nephrology, Endocrinology, and Vascular Medicine, Department of Medicine (R.M., M.K., Y.I., Y.O., M.N., K.O., S.I., F.S.), Tohoku University Hospital, 1-1 Seiryo, Aoba, Sendai 980-8574, Japan.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Nezu
authors.affiliation: From the Department of Diagnostic Radiology (N.S., H.O., K.S., K.T.) and Division of Nephrology, Endocrinology, and Vascular Medicine, Department of Medicine (R.M., M.K., Y.I., Y.O., M.N., K.O., S.I., F.S.), Tohoku University Hospital, 1-1 Seiryo, Aoba, Sendai 980-8574, Japan.
authors.forename: Kei
authors.initials: K
authors.lastname: Omata
authors.affiliation: From the Department of Diagnostic Radiology (N.S., H.O., K.S., K.T.) and Division of Nephrology, Endocrinology, and Vascular Medicine, Department of Medicine (R.M., M.K., Y.I., Y.O., M.N., K.O., S.I., F.S.), Tohoku University Hospital, 1-1 Seiryo, Aoba, Sendai 980-8574, Japan.
authors.forename: Sadayoshi
authors.initials: S
authors.lastname: Ito
authors.affiliation: From the Department of Diagnostic Radiology (N.S., H.O., K.S., K.T.) and Division of Nephrology, Endocrinology, and Vascular Medicine, Department of Medicine (R.M., M.K., Y.I., Y.O., M.N., K.O., S.I., F.S.), Tohoku University Hospital, 1-1 Seiryo, Aoba, Sendai 980-8574, Japan.
authors.forename: Fumitoshi
authors.initials: F
authors.lastname: Satoh
authors.affiliation: From the Department of Diagnostic Radiology (N.S., H.O., K.S., K.T.) and Division of Nephrology, Endocrinology, and Vascular Medicine, Department of Medicine (R.M., M.K., Y.I., Y.O., M.N., K.O., S.I., F.S.), Tohoku University Hospital, 1-1 Seiryo, Aoba, Sendai 980-8574, Japan.
authors.forename: Kei
authors.initials: K
authors.lastname: Takase
mesh_terms: D000311:Adrenal Glands / Q000098:blood supply* / Q000378:metabolism*; D000328:Adult; D000368:Aged; D000450:Aldosterone / Q000097:blood*; D000792:Angiography; D005260:Female; D006801:Humans; D006929:Hyperaldosteronism / Q000097:blood*; D008297:Male; D008875:Middle Aged; D010690:Phlebography / Q000379:methods*; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods*
chemical_list: D000450:Aldosterone