title: Clinical Management and Outcomes of Adrenal Hemorrhage Following Adrenal Vein Sampling in Primary Aldosteronism.
abstract: Aldosterone-producing adenoma and bilateral adrenal hyperplasia account for >90% of all primary aldosteronism cases. Distinguishing between bilateral and unilateral disease is of fundamental importance because it allows targeted therapy. Adrenal vein sampling (AVS) is the only reliable means to preoperatively differentiate between unilateral and bilateral subtypes. A rare but serious complication of AVS is an adrenal hemorrhage (AH). We retrospectively examined in detail 24 cases of AH during AVS in 6 different referral hypertension centers. AH more often affected the right adrenal (n=18) than the left (n=5, P<0.001); 1 bilateral. Median duration of experience of the radiologist in AVS at the time of AH was 5.0 years (0.6-7.8) and AH occurred with both highly experienced (>10 years) and less experienced radiologists. Of 9 patients who suffered AH in the gland contralateral to an aldosterone-producing adenoma and who underwent complete (n=6) or partial (n=3) unilateral adrenalectomy, only one required long-term corticosteroid replacement for adrenal insufficiency. No reduction in blood pressure or biochemical resolution of primary aldosteronism occurred in any of those patients who experienced AH in the gland ipsilateral to an aldosterone-producing adenoma (n=6) or who had bilateral adrenal hyperplasia (n=9). No patient required invasive treatments to control bleeding or blood transfusion. In conclusion, AH usually has a positive outcome causing either no or minor effects on adrenal function, and AVS should remain the best approach to primary aldosteronism subtype differentiation.
authors.affiliation: From the Division of Internal Medicine and Hypertension, Department of Medical Sciences, University of Torino, Torino, Italy (S.M., P.M.); Division of Clinical Hypertension, Endocrinology & Metabolism, Tohoku University Graduate School of Medicine, Sendai, Japan (F.S., R.M.); Endocrine Hypertension Research Centre, University of Queensland School of Medicine, Greenslopes and Princess Alexandra Hospitals, Brisbane, Queensland, Australia (R.G., R.D.G., M.S.); Unit of Internal Medicine, Department of Medicine, University of Verona, Verona, Italy (F.P.); Department of Internal Medicine I, University Hospital Wuerzburg, Wuerzburg, Germany (K.L.); and Medizinische Klinik und Poliklinik IV, Ludwig-Maximilians-Universität, Munich, Germany (A.S.D., M.R.).
authors.forename: Silvia
authors.initials: S
authors.lastname: Monticone
authors.affiliation: From the Division of Internal Medicine and Hypertension, Department of Medical Sciences, University of Torino, Torino, Italy (S.M., P.M.); Division of Clinical Hypertension, Endocrinology & Metabolism, Tohoku University Graduate School of Medicine, Sendai, Japan (F.S., R.M.); Endocrine Hypertension Research Centre, University of Queensland School of Medicine, Greenslopes and Princess Alexandra Hospitals, Brisbane, Queensland, Australia (R.G., R.D.G., M.S.); Unit of Internal Medicine, Department of Medicine, University of Verona, Verona, Italy (F.P.); Department of Internal Medicine I, University Hospital Wuerzburg, Wuerzburg, Germany (K.L.); and Medizinische Klinik und Poliklinik IV, Ludwig-Maximilians-Universität, Munich, Germany (A.S.D., M.R.).
authors.forename: Fumitoshi
authors.initials: F
authors.lastname: Satoh
authors.affiliation: From the Division of Internal Medicine and Hypertension, Department of Medical Sciences, University of Torino, Torino, Italy (S.M., P.M.); Division of Clinical Hypertension, Endocrinology & Metabolism, Tohoku University Graduate School of Medicine, Sendai, Japan (F.S., R.M.); Endocrine Hypertension Research Centre, University of Queensland School of Medicine, Greenslopes and Princess Alexandra Hospitals, Brisbane, Queensland, Australia (R.G., R.D.G., M.S.); Unit of Internal Medicine, Department of Medicine, University of Verona, Verona, Italy (F.P.); Department of Internal Medicine I, University Hospital Wuerzburg, Wuerzburg, Germany (K.L.); and Medizinische Klinik und Poliklinik IV, Ludwig-Maximilians-Universität, Munich, Germany (A.S.D., M.R.).
authors.forename: Anna S
authors.initials: AS
authors.lastname: Dietz
authors.affiliation: From the Division of Internal Medicine and Hypertension, Department of Medical Sciences, University of Torino, Torino, Italy (S.M., P.M.); Division of Clinical Hypertension, Endocrinology & Metabolism, Tohoku University Graduate School of Medicine, Sendai, Japan (F.S., R.M.); Endocrine Hypertension Research Centre, University of Queensland School of Medicine, Greenslopes and Princess Alexandra Hospitals, Brisbane, Queensland, Australia (R.G., R.D.G., M.S.); Unit of Internal Medicine, Department of Medicine, University of Verona, Verona, Italy (F.P.); Department of Internal Medicine I, University Hospital Wuerzburg, Wuerzburg, Germany (K.L.); and Medizinische Klinik und Poliklinik IV, Ludwig-Maximilians-Universität, Munich, Germany (A.S.D., M.R.).
authors.forename: Remi
authors.initials: R
authors.lastname: Goupil
authors.affiliation: From the Division of Internal Medicine and Hypertension, Department of Medical Sciences, University of Torino, Torino, Italy (S.M., P.M.); Division of Clinical Hypertension, Endocrinology & Metabolism, Tohoku University Graduate School of Medicine, Sendai, Japan (F.S., R.M.); Endocrine Hypertension Research Centre, University of Queensland School of Medicine, Greenslopes and Princess Alexandra Hospitals, Brisbane, Queensland, Australia (R.G., R.D.G., M.S.); Unit of Internal Medicine, Department of Medicine, University of Verona, Verona, Italy (F.P.); Department of Internal Medicine I, University Hospital Wuerzburg, Wuerzburg, Germany (K.L.); and Medizinische Klinik und Poliklinik IV, Ludwig-Maximilians-Universität, Munich, Germany (A.S.D., M.R.).
authors.forename: Katharina
authors.initials: K
authors.lastname: Lang
authors.affiliation: From the Division of Internal Medicine and Hypertension, Department of Medical Sciences, University of Torino, Torino, Italy (S.M., P.M.); Division of Clinical Hypertension, Endocrinology & Metabolism, Tohoku University Graduate School of Medicine, Sendai, Japan (F.S., R.M.); Endocrine Hypertension Research Centre, University of Queensland School of Medicine, Greenslopes and Princess Alexandra Hospitals, Brisbane, Queensland, Australia (R.G., R.D.G., M.S.); Unit of Internal Medicine, Department of Medicine, University of Verona, Verona, Italy (F.P.); Department of Internal Medicine I, University Hospital Wuerzburg, Wuerzburg, Germany (K.L.); and Medizinische Klinik und Poliklinik IV, Ludwig-Maximilians-Universität, Munich, Germany (A.S.D., M.R.).
authors.forename: Francesca
authors.initials: F
authors.lastname: Pizzolo
authors.affiliation: From the Division of Internal Medicine and Hypertension, Department of Medical Sciences, University of Torino, Torino, Italy (S.M., P.M.); Division of Clinical Hypertension, Endocrinology & Metabolism, Tohoku University Graduate School of Medicine, Sendai, Japan (F.S., R.M.); Endocrine Hypertension Research Centre, University of Queensland School of Medicine, Greenslopes and Princess Alexandra Hospitals, Brisbane, Queensland, Australia (R.G., R.D.G., M.S.); Unit of Internal Medicine, Department of Medicine, University of Verona, Verona, Italy (F.P.); Department of Internal Medicine I, University Hospital Wuerzburg, Wuerzburg, Germany (K.L.); and Medizinische Klinik und Poliklinik IV, Ludwig-Maximilians-Universität, Munich, Germany (A.S.D., M.R.).
authors.forename: Richard D
authors.initials: RD
authors.lastname: Gordon
authors.affiliation: From the Division of Internal Medicine and Hypertension, Department of Medical Sciences, University of Torino, Torino, Italy (S.M., P.M.); Division of Clinical Hypertension, Endocrinology & Metabolism, Tohoku University Graduate School of Medicine, Sendai, Japan (F.S., R.M.); Endocrine Hypertension Research Centre, University of Queensland School of Medicine, Greenslopes and Princess Alexandra Hospitals, Brisbane, Queensland, Australia (R.G., R.D.G., M.S.); Unit of Internal Medicine, Department of Medicine, University of Verona, Verona, Italy (F.P.); Department of Internal Medicine I, University Hospital Wuerzburg, Wuerzburg, Germany (K.L.); and Medizinische Klinik und Poliklinik IV, Ludwig-Maximilians-Universität, Munich, Germany (A.S.D., M.R.).
authors.forename: Ryo
authors.initials: R
authors.lastname: Morimoto
authors.affiliation: From the Division of Internal Medicine and Hypertension, Department of Medical Sciences, University of Torino, Torino, Italy (S.M., P.M.); Division of Clinical Hypertension, Endocrinology & Metabolism, Tohoku University Graduate School of Medicine, Sendai, Japan (F.S., R.M.); Endocrine Hypertension Research Centre, University of Queensland School of Medicine, Greenslopes and Princess Alexandra Hospitals, Brisbane, Queensland, Australia (R.G., R.D.G., M.S.); Unit of Internal Medicine, Department of Medicine, University of Verona, Verona, Italy (F.P.); Department of Internal Medicine I, University Hospital Wuerzburg, Wuerzburg, Germany (K.L.); and Medizinische Klinik und Poliklinik IV, Ludwig-Maximilians-Universität, Munich, Germany (A.S.D., M.R.).
authors.forename: Martin
authors.initials: M
authors.lastname: Reincke
authors.affiliation: From the Division of Internal Medicine and Hypertension, Department of Medical Sciences, University of Torino, Torino, Italy (S.M., P.M.); Division of Clinical Hypertension, Endocrinology & Metabolism, Tohoku University Graduate School of Medicine, Sendai, Japan (F.S., R.M.); Endocrine Hypertension Research Centre, University of Queensland School of Medicine, Greenslopes and Princess Alexandra Hospitals, Brisbane, Queensland, Australia (R.G., R.D.G., M.S.); Unit of Internal Medicine, Department of Medicine, University of Verona, Verona, Italy (F.P.); Department of Internal Medicine I, University Hospital Wuerzburg, Wuerzburg, Germany (K.L.); and Medizinische Klinik und Poliklinik IV, Ludwig-Maximilians-Universität, Munich, Germany (A.S.D., M.R.).
authors.forename: Michael
authors.initials: M
authors.lastname: Stowasser
authors.affiliation: From the Division of Internal Medicine and Hypertension, Department of Medical Sciences, University of Torino, Torino, Italy (S.M., P.M.); Division of Clinical Hypertension, Endocrinology & Metabolism, Tohoku University Graduate School of Medicine, Sendai, Japan (F.S., R.M.); Endocrine Hypertension Research Centre, University of Queensland School of Medicine, Greenslopes and Princess Alexandra Hospitals, Brisbane, Queensland, Australia (R.G., R.D.G., M.S.); Unit of Internal Medicine, Department of Medicine, University of Verona, Verona, Italy (F.P.); Department of Internal Medicine I, University Hospital Wuerzburg, Wuerzburg, Germany (K.L.); and Medizinische Klinik und Poliklinik IV, Ludwig-Maximilians-Universität, Munich, Germany (A.S.D., M.R.). paolo.mulatero@libero.it.
authors.forename: Paolo
authors.initials: P
authors.lastname: Mulatero
mesh_terms: D000311:Adrenal Glands / Q000098:blood supply*; D000315:Adrenalectomy; D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006489:Hemostatic Techniques; D006801:Humans; D006929:Hyperaldosteronism / Q000175:diagnosis* / Q000601:surgery; D006965:Hyperplasia; D008297:Male; D008875:Middle Aged; D019106:Postoperative Hemorrhage / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014680:Veins / Q000473:pathology / Q000601:surgery*
keywords: adrenal hemorrhage; adrenal vein sampling; aldosterone-producing adenoma; bilateral adrenal hyperplasia; primary aldosteronism