title: Optimization of left adrenal vein sampling in primary aldosteronism: Coping with asymmetrical cortisol secretion.
abstract: We evaluated the influence of catheter sampling position and size on left adrenal venous sampling (AVS) in patients with primary aldosteronism (PA) and analyzed their relationship to cortisol secretion. This retrospective study included 111 patients with a diagnosis of primary aldosteronism who underwent tetracosactide-stimulated AVS. Left AVS was obtained from two catheter positions - the central adrenal vein (CAV) and the common trunk. For common trunk sampling, 5-French catheters were used in 51 patients, and microcatheters were used in 60 patients. Autonomous cortisol secretion was evaluated with a low-dose dexamethasone suppression test in 87 patients. The adrenal/inferior vena cava cortisol concentration ratio [selectivity index (SI)] was significantly lower in samples from the left common trunk than those of the left CAV and right adrenal veins, but this difference was reduced when a microcatheter was used for common trunk sampling. Sample dilution in the common trunk of the left adrenal vein can be decreased by limiting sampling speed with the use of a microcatheter. Meanwhile, there was no significant difference in SI between the left CAV and right adrenal veins. Laterality, determined according to aldosterone/cortisol ratio (A/C ratio) based criteria, showed good reproducibility regardless of sampling position, unlike the absolute aldosterone value based criteria. However, in 11 cases with autonomous cortisol co-secretion, the cortisol hypersecreting side tended to be underestimated when using A/C ratio based criteria. Left CAV sampling enables symmetrical sampling, and may be essential when using absolute aldosterone value based criteria in cases where symmetrical cortisol secretion is uncertain.
authors.affiliation: Department of Diagnostic Radiology and Nuclear Medicine, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo 113-8519, Japan.
authors.forename: Mitsuhiro
authors.initials: M
authors.lastname: Kishino
authors.forename: Takanobu
authors.initials: T
authors.lastname: Yoshimoto
authors.forename: Masashi
authors.initials: M
authors.lastname: Nakadate
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Katada
authors.forename: Eiichiro
authors.initials: E
authors.lastname: Kanda
authors.forename: Shuichiro
authors.initials: S
authors.lastname: Nakaminato
authors.forename: Yukihisa
authors.initials: Y
authors.lastname: Saida
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Ogawa
authors.forename: Ukihide
authors.initials: U
authors.lastname: Tateishi
mesh_terms: D000306:Adrenal Cortex Neoplasms / Q000175:diagnosis / Q000378:metabolism / Q000503:physiopathology; D000311:Adrenal Glands / Q000098:blood supply* / Q000187:drug effects / Q000378:metabolism; D018246:Adrenocortical Adenoma / Q000175:diagnosis / Q000378:metabolism / Q000503:physiopathology; D000450:Aldosterone / Q000819:agonists / Q000097:blood* / Q000378:metabolism; D058070:Asymptomatic Diseases; D002404:Catheterization / Q000295:instrumentation*; D003366:Cosyntropin / Q000494:pharmacology; D003480:Cushing Syndrome / Q000175:diagnosis / Q000503:physiopathology; D003907:Dexamethasone / Q000494:pharmacology; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000037:antagonists & inhibitors / Q000097:blood* / Q000378:metabolism; D006929:Hyperaldosteronism / Q000097:blood* / Q000209:etiology / Q000378:metabolism / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D018962:Phlebotomy / Q000295:instrumentation*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012720:Severity of Illness Index; D014680:Veins; D014682:Vena Cava, Inferior
chemical_list: D003366:Cosyntropin; D000450:Aldosterone; D003907:Dexamethasone; D006854:Hydrocortisone