title: Role of adrenal vein sampling in primary aldosteronism: Impact of imaging, localization, and age.
abstract: BACKGROUND
  The role of adrenal vein sampling (AVS) has been debated, with some authorities advocating selective use in younger patients (≤40 years), and those localized by preoperative imaging. We examined our experience to determine the impact of AVS in patients who routinely underwent AVS with a high success rate.
  
  
  METHODS
  A retrospective cohort study was performed using a prospectively maintained database of patients referred for evaluation of PA (1997-2013). Patients were classified as localized (L) if a unilateral mass was identified on imaging, and non-localized (NL) otherwise.
  
  
  RESULTS
  Of 367 patients, 94% (n = 345) underwent successful AVS. Seventy-two percent (n = 265) were L; AVS was lateralizing 58% (n = 214). AVS changed management in 43% of patients (n = 158). In patients ≤40 years, AVS changed management in 30% (n = 15). In patients ≤40 years with a ≥1 cm adrenal mass, 12% (n = 3) would have undergone unnecessary surgery based on imaging results alone; in patients >40 years with a ≥1 cm adrenal mass, 3% (n = 5) would have undergone wrong-side surgery, and 30% (n = 50) would have undergone unnecessary surgery based on imaging.
  
  
  CONCLUSIONS
  AVS changed management in a significant minority of patients regardless of age and imaging findings. AVS should be routinely recommended in all patients with PA, to direct operative therapy. J. Surg. Oncol. 2016;113:532-537. © 2016 Wiley Periodicals, Inc.
authors.affiliation: Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Heather
authors.initials: H
authors.lastname: Wachtel
authors.affiliation: Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Salman
authors.initials: S
authors.lastname: Zaheer
authors.affiliation: Department of Surgery, Creighton University Medical Center, Omeha, Nebraska.
authors.forename: Parth K
authors.initials: PK
authors.lastname: Shah
authors.affiliation: Department of Radiology, Division of Vascular and Interventional Radiology, Hospital of the University of, Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Scott O
authors.initials: SO
authors.lastname: Trerotola
authors.affiliation: Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Giorgos C
authors.initials: GC
authors.lastname: Karakousis
authors.affiliation: Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Robert E
authors.initials: RE
authors.lastname: Roses
authors.affiliation: Department of Medicine, Division of Renal, Electrolyte, and Hypertension, Hospital of the University of, Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Debbie L
authors.initials: DL
authors.lastname: Cohen
authors.affiliation: Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Douglas L
authors.initials: DL
authors.lastname: Fraker
mesh_terms: D000311:Adrenal Glands / Q000098:blood supply*; D000315:Adrenalectomy; D000328:Adult; D000367:Age Factors; D000368:Aged; D000450:Aldosterone / Q000097:blood*; D001800:Blood Specimen Collection; D005260:Female; D006801:Humans; D006929:Hyperaldosteronism / Q000097:blood* / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D012189:Retrospective Studies; D014680:Veins
chemical_list: D000450:Aldosterone
keywords: adrenal vein sampling; age; aldosteronoma; primary aldosteronism