A Novel Method: Super-selective Adrenal Venous Sampling

Abstract

Primary aldosteronism (PA) and subclinical Cushing's syndrome (SCS) are conditions in which the adrenal glands autonomously produce excessive amounts of aldosterone and cortisol, respectively. The conventional adrenal venous sampling (cAVS) method collects blood samples from both adrenal central veins and is useful for identifying the laterality of excess hormone production in a unilateral lesion(s), as documented in PA cases. In cAVS, plasma cortisol concentrations (PCCs) are used to normalize plasma aldosterone concentrations (PACs). A novel "super-selective" adrenal venous sampling (ssAVS) method was developed using a micro-catheter, which collects blood samples from adrenal tributary veins (TVs). PACs in ssAVS samples do not require PCC normalization because samples contain a limited amount of systemic venous blood, if any. The ssAVS method enabled segmental lesion(s) to be detected in both adrenal glands, which may be treated by bilateral adrenalectomy, thereby sparing lesion-free segment(s). Right and left adrenals typically have three TVs each, i.e., the superior, lateral, and inferior TVs in the right adrenal as well as the superior-median, superior-lateral, and lateral TVs in the left adrenal. In the ssAVS method, specific parent catheters and a technique to handle them are required, and have been described herein. Furthermore, ssAVS results from three cases of PA are presented: bilateral aldosterone-producing adenoma (APA) (Case #1), left APA and right possible cortisol-producing adenoma causing SCS (Case #2), and idiopathic hyperaldosteronism in which bilateral adrenal segments produced excessive amounts of aldosterone (Case #3). The ssAVS method is not difficult for expert angiographers, and, thus, is recommended worldwide to treat PA cases for which cAVS does not represent a viable surgical treatment option.

Histological complete response with nivolumab for renal cell carcinoma with multiple metastases: A case report

“…2E and F, and 2G and H (enlarged image of the yellow arrowheads in Fig. 2E and F)] as previously reported (7). The inner tissue of the tumor was completely occupied by fibrotic tissue, into which only a few T cells had infiltrated [# the right side of Fig.…”

Clinical characterization of patients with primary aldosteronism plus subclinical Cushing’s syndrome

“…The following terms were defined for PASCS: hypertension, SBP ≥ 140 mmHg and/or DBP ≥ 90 mmHg [14]; diabetes mellitus (DM), an fasting plasma glucose (FPG) level ≥ 126 mg/dL, a 2-h plasma glucose level ≥ 200 mg/ dL in the 75-g oral glucose tolerance test, and/or a serum hemoglobin A1c (HbA1c) level ≥ 6.5% in national glycohemoglobin standardization program [15]; and dyslipidemia, a serum triglyceride (TG) level ≥ 150 mg/dL, a serum high-density lipoprotein cholesterol (HDL-C) level < 40 mg/dL, or a serum low-density lipoprotein cholesterol (LDL-C) level ≥ 140 mg/dL [16]. To specify the source of aldosterone hypersecretion by AVS, the following diagnostic criteria were used: 1) the laterality ratio (LR) and the contralaterality ratio (CR) calculated before and after the ACTH challenge test in reference to the Japanese guidelines of PA [11]; 2) the absolute PAC value of ≥ 14,000 pg/mL in reference to the articles of Ohmura [17] and Makita [18]; and 3) the aldosterone ratio of the right and left adrenal veins. According to the Japanese guidelines of PA [11], an LR of > 4 and a CR of < 1 after the ACTH challenge test were used as the cutoff values.…”

Role of Venous Sampling in the Diagnosis of Endocrine Disorders

“…Recent studies have described “super-selective” adrenal venous sampling (ssAVS), whereby tributaries of each adrenal vein (superior, lateral, and inferior) are sampled with a microcatheter [ 48 , 49 , 50 , 51 ]. This technique may allow for detection of segmental adrenal lesions, allowing for partial bilateral adrenalectomies that spares normal adrenal tissue.…”