title: Is there a role for segmental adrenal venous sampling and adrenal sparing surgery in patients with primary aldosteronism?
abstract: OBJECTIVE
  Adrenal venous sampling (AVS) is critical to determine the subtype of primary aldosteronism (PA). Central AVS (C-AVS)--that is, the collection of effluents from bilateral adrenal central veins (CV)--sometimes does not allow differentiation between bilateral aldosterone-producing adenomas (APA) and idiopathic hyperaldosteronism. To establish the best treatment course, we have developed segmental AVS (S-AVS); that is, we collect effluents from the tributaries of CV to determine the intra-adrenal sources of aldosterone overproduction. We then evaluated the clinical utility of this novel approach in the diagnosis and treatment of PA.
  
  
  METHODS
  We performed C-AVS and/or S-AVS in 297 PA patients and assessed the accuracy of diagnosis based on the results of C-AVS (n=138, 46.5%) and S-AVS (n=159, 53.5%) by comparison with those of clinicopathological evaluation of resected specimens.
  
  
  RESULTS
  S-AVS demonstrated both elevated and attenuated secretion of aldosterone from APA and non-tumorous segments, respectively, in patients with bilateral APA and recurrent APA. These findings were completely confirmed by detailed histopathological examination after surgery. S-AVS, but not C-AVS, also served to identify APA located distal from the CV.
  
  
  CONCLUSIONS
  Compared to C-AVS, S-AVS served to identify APA in some patients, and its use should expand the pool of patients eligible for adrenal sparing surgery through the identification of unaffected segments, despite the fact that S-AVS requires more expertise and time. Especially, this new technique could enormously benefit patients with bilateral or recurrent APA because of the preservation of non-tumorous glandular tissue.
authors.affiliation: Division of Clinical HypertensionEndocrinology and Metabolism, Tohoku University Graduate School of Medicine, Sendai, Miyagi, JapanDivision of NephrologyEndocrinology and Vascular Medicine, Department of MedicineDepartment of Diagnostic RadiologyDepartment of UrologyDepartment of PathologyTohoku University Hospital, Sendai, Miyagi 980-8574, Japan Division of Clinical HypertensionEndocrinology and Metabolism, Tohoku University Graduate School of Medicine, Sendai, Miyagi, JapanDivision of NephrologyEndocrinology and Vascular Medicine, Department of MedicineDepartment of Diagnostic RadiologyDepartment of UrologyDepartment of PathologyTohoku University Hospital, Sendai, Miyagi 980-8574, Japan fsatoh@med.tohoku.ac.jp.
authors.forename: Fumitoshi
authors.initials: F
authors.lastname: Satoh
authors.affiliation: Division of Clinical HypertensionEndocrinology and Metabolism, Tohoku University Graduate School of Medicine, Sendai, Miyagi, JapanDivision of NephrologyEndocrinology and Vascular Medicine, Department of MedicineDepartment of Diagnostic RadiologyDepartment of UrologyDepartment of PathologyTohoku University Hospital, Sendai, Miyagi 980-8574, Japan.
authors.forename: Ryo
authors.initials: R
authors.lastname: Morimoto
authors.affiliation: Division of Clinical HypertensionEndocrinology and Metabolism, Tohoku University Graduate School of Medicine, Sendai, Miyagi, JapanDivision of NephrologyEndocrinology and Vascular Medicine, Department of MedicineDepartment of Diagnostic RadiologyDepartment of UrologyDepartment of PathologyTohoku University Hospital, Sendai, Miyagi 980-8574, Japan.
authors.forename: Kazumasa
authors.initials: K
authors.lastname: Seiji
authors.affiliation: Division of Clinical HypertensionEndocrinology and Metabolism, Tohoku University Graduate School of Medicine, Sendai, Miyagi, JapanDivision of NephrologyEndocrinology and Vascular Medicine, Department of MedicineDepartment of Diagnostic RadiologyDepartment of UrologyDepartment of PathologyTohoku University Hospital, Sendai, Miyagi 980-8574, Japan.
authors.forename: Nozomi
authors.initials: N
authors.lastname: Satani
authors.affiliation: Division of Clinical HypertensionEndocrinology and Metabolism, Tohoku University Graduate School of Medicine, Sendai, Miyagi, JapanDivision of NephrologyEndocrinology and Vascular Medicine, Department of MedicineDepartment of Diagnostic RadiologyDepartment of UrologyDepartment of PathologyTohoku University Hospital, Sendai, Miyagi 980-8574, Japan.
authors.forename: Hideki
authors.initials: H
authors.lastname: Ota
authors.affiliation: Division of Clinical HypertensionEndocrinology and Metabolism, Tohoku University Graduate School of Medicine, Sendai, Miyagi, JapanDivision of NephrologyEndocrinology and Vascular Medicine, Department of MedicineDepartment of Diagnostic RadiologyDepartment of UrologyDepartment of PathologyTohoku University Hospital, Sendai, Miyagi 980-8574, Japan.
authors.forename: Yoshitsugu
authors.initials: Y
authors.lastname: Iwakura
authors.affiliation: Division of Clinical HypertensionEndocrinology and Metabolism, Tohoku University Graduate School of Medicine, Sendai, Miyagi, JapanDivision of NephrologyEndocrinology and Vascular Medicine, Department of MedicineDepartment of Diagnostic RadiologyDepartment of UrologyDepartment of PathologyTohoku University Hospital, Sendai, Miyagi 980-8574, Japan.
authors.forename: Yoshikiyo
authors.initials: Y
authors.lastname: Ono
authors.affiliation: Division of Clinical HypertensionEndocrinology and Metabolism, Tohoku University Graduate School of Medicine, Sendai, Miyagi, JapanDivision of NephrologyEndocrinology and Vascular Medicine, Department of MedicineDepartment of Diagnostic RadiologyDepartment of UrologyDepartment of PathologyTohoku University Hospital, Sendai, Miyagi 980-8574, Japan.
authors.forename: Masataka
authors.initials: M
authors.lastname: Kudo
authors.affiliation: Division of Clinical HypertensionEndocrinology and Metabolism, Tohoku University Graduate School of Medicine, Sendai, Miyagi, JapanDivision of NephrologyEndocrinology and Vascular Medicine, Department of MedicineDepartment of Diagnostic RadiologyDepartment of UrologyDepartment of PathologyTohoku University Hospital, Sendai, Miyagi 980-8574, Japan.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Nezu
authors.affiliation: Division of Clinical HypertensionEndocrinology and Metabolism, Tohoku University Graduate School of Medicine, Sendai, Miyagi, JapanDivision of NephrologyEndocrinology and Vascular Medicine, Department of MedicineDepartment of Diagnostic RadiologyDepartment of UrologyDepartment of PathologyTohoku University Hospital, Sendai, Miyagi 980-8574, Japan Division of Clinical HypertensionEndocrinology and Metabolism, Tohoku University Graduate School of Medicine, Sendai, Miyagi, JapanDivision of NephrologyEndocrinology and Vascular Medicine, Department of MedicineDepartment of Diagnostic RadiologyDepartment of UrologyDepartment of PathologyTohoku University Hospital, Sendai, Miyagi 980-8574, Japan.
authors.forename: Kei
authors.initials: K
authors.lastname: Omata
authors.affiliation: Division of Clinical HypertensionEndocrinology and Metabolism, Tohoku University Graduate School of Medicine, Sendai, Miyagi, JapanDivision of NephrologyEndocrinology and Vascular Medicine, Department of MedicineDepartment of Diagnostic RadiologyDepartment of UrologyDepartment of PathologyTohoku University Hospital, Sendai, Miyagi 980-8574, Japan Division of Clinical HypertensionEndocrinology and Metabolism, Tohoku University Graduate School of Medicine, Sendai, Miyagi, JapanDivision of NephrologyEndocrinology and Vascular Medicine, Department of MedicineDepartment of Diagnostic RadiologyDepartment of UrologyDepartment of PathologyTohoku University Hospital, Sendai, Miyagi 980-8574, Japan.
authors.forename: Yuta
authors.initials: Y
authors.lastname: Tezuka
authors.affiliation: Division of Clinical HypertensionEndocrinology and Metabolism, Tohoku University Graduate School of Medicine, Sendai, Miyagi, JapanDivision of NephrologyEndocrinology and Vascular Medicine, Department of MedicineDepartment of Diagnostic RadiologyDepartment of UrologyDepartment of PathologyTohoku University Hospital, Sendai, Miyagi 980-8574, Japan.
authors.forename: Yoshihide
authors.initials: Y
authors.lastname: Kawasaki
authors.affiliation: Division of Clinical HypertensionEndocrinology and Metabolism, Tohoku University Graduate School of Medicine, Sendai, Miyagi, JapanDivision of NephrologyEndocrinology and Vascular Medicine, Department of MedicineDepartment of Diagnostic RadiologyDepartment of UrologyDepartment of PathologyTohoku University Hospital, Sendai, Miyagi 980-8574, Japan.
authors.forename: Shigeto
authors.initials: S
authors.lastname: Ishidoya
authors.affiliation: Division of Clinical HypertensionEndocrinology and Metabolism, Tohoku University Graduate School of Medicine, Sendai, Miyagi, JapanDivision of NephrologyEndocrinology and Vascular Medicine, Department of MedicineDepartment of Diagnostic RadiologyDepartment of UrologyDepartment of PathologyTohoku University Hospital, Sendai, Miyagi 980-8574, Japan.
authors.forename: Yoichi
authors.initials: Y
authors.lastname: Arai
authors.affiliation: Division of Clinical HypertensionEndocrinology and Metabolism, Tohoku University Graduate School of Medicine, Sendai, Miyagi, JapanDivision of NephrologyEndocrinology and Vascular Medicine, Department of MedicineDepartment of Diagnostic RadiologyDepartment of UrologyDepartment of PathologyTohoku University Hospital, Sendai, Miyagi 980-8574, Japan.
authors.forename: Kei
authors.initials: K
authors.lastname: Takase
authors.affiliation: Division of Clinical HypertensionEndocrinology and Metabolism, Tohoku University Graduate School of Medicine, Sendai, Miyagi, JapanDivision of NephrologyEndocrinology and Vascular Medicine, Department of MedicineDepartment of Diagnostic RadiologyDepartment of UrologyDepartment of PathologyTohoku University Hospital, Sendai, Miyagi 980-8574, Japan.
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Nakamura
authors.affiliation: Division of Clinical HypertensionEndocrinology and Metabolism, Tohoku University Graduate School of Medicine, Sendai, Miyagi, JapanDivision of NephrologyEndocrinology and Vascular Medicine, Department of MedicineDepartment of Diagnostic RadiologyDepartment of UrologyDepartment of PathologyTohoku University Hospital, Sendai, Miyagi 980-8574, Japan.
authors.forename: Keely
authors.initials: K
authors.lastname: McNamara
authors.affiliation: Division of Clinical HypertensionEndocrinology and Metabolism, Tohoku University Graduate School of Medicine, Sendai, Miyagi, JapanDivision of NephrologyEndocrinology and Vascular Medicine, Department of MedicineDepartment of Diagnostic RadiologyDepartment of UrologyDepartment of PathologyTohoku University Hospital, Sendai, Miyagi 980-8574, Japan.
authors.forename: Hironobu
authors.initials: H
authors.lastname: Sasano
authors.affiliation: Division of Clinical HypertensionEndocrinology and Metabolism, Tohoku University Graduate School of Medicine, Sendai, Miyagi, JapanDivision of NephrologyEndocrinology and Vascular Medicine, Department of MedicineDepartment of Diagnostic RadiologyDepartment of UrologyDepartment of PathologyTohoku University Hospital, Sendai, Miyagi 980-8574, Japan.
authors.forename: Sadayoshi
authors.initials: S
authors.lastname: Ito
mesh_terms: D000306:Adrenal Cortex Neoplasms / Q000175:diagnosis* / Q000378:metabolism / Q000601:surgery; D000311:Adrenal Glands / Q000098:blood supply*; D000315:Adrenalectomy / Q000379:methods; D018246:Adrenocortical Adenoma / Q000175:diagnosis* / Q000378:metabolism / Q000601:surgery; D000450:Aldosterone / Q000378:metabolism*; D001800:Blood Specimen Collection / Q000379:methods*; D005260:Female; D006801:Humans; D006929:Hyperaldosteronism / Q000145:classification / Q000175:diagnosis* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D059351:Organ Sparing Treatments; D014680:Veins
chemical_list: D000450:Aldosterone