A single-centre experience of the implementation of adrenal vein sampling procedure: the impact on the diagnostic work-up in primary aldosteronism

Kądziela, Jacek; Prejbisz, Aleksander; Michałowska, Ilona; Kołodziejczyk-Kruk, Sylwia; Kool, Leo Schultze; Kabat, Marek; Janaszek−Sitkowska, Hanna; Toutounchi, Sadegh; Gałązka, Zbigniew; Ambroziak, Urszula; Bednarczuk, Tomasz; Ptasinska-Wnuk, Dorota; Hoffmann, Michal; Januszewicz, Magdalena; Januszewicz, Andrzej; Witkowski, Adam

doi:10.5603/kp.a2016.0166

Cited by 5 publications

(3 citation statements)

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“…We obtained a high technical success rate of AVS (95%) with acceptable procedure time, owing to visualization of the right adrenal vein with AMI; this result is almost the same as in the literature (14,15). We think one reason for the difficulty of cannulation into the right adrenal vein may be the presence of the accessory hepatic vein.…”

Section: Discussionsupporting

confidence: 82%

Advanced monoenergetic reconstruction technique in dual-energy computed tomography for evaluation of vascular anatomy before adrenal vein sampling

et al. 2019

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Background In adrenal vein sampling, selecting the right adrenal vein is technically difficult and it is important to evaluate the right adrenal vein anatomy before adrenal vein sampling. The advanced monoenergetic reconstruction technique has recently become available and we hypothesized that this technique may be useful. Purpose To evaluate the usefulness of the advanced monoenergetic reconstruction technique in dual-energy computed tomography (CT; advanced monoenergetic images) for evaluation of vascular anatomy before adrenal vein sampling. Material and Methods Twenty-one patients underwent three-phase (20, 30, and 70 s) contrast-enhanced CT before adrenal vein sampling. Advanced monoenergetic images were reconstructed at 40 keV and analyzed objectively and subjectively in comparison with the standard 120-kVp images. As objective evaluation, the signal-to-noise ratio and contrast-to-noise ratio of the right adrenal vein were assessed. As subjective evaluation, two radiologists assessed the delineation of the right adrenal vein using a 5-point Likert scale (1 = poor, 5 = excellent). Furthermore, the technical success rate of adrenal vein sampling and procedure time were also evaluated. Results There was no difference in the signal-to-noise ratio between the two groups. The contrast-to-noise ratios of the right adrenal vein of advanced monoenergetic images were higher than those of the standard images ( P < 0.05). The Likert scores of advanced monoenergetic images were higher than those of the standard images ( P < 0.05). The technical success rate of adrenal vein sampling was 95% (20/21) and the median of procedure time was 103 min (range = 59–197 min). Conclusion Advanced monoenergetic imaging appears to be useful in the delineation of the right adrenal vein before adrenal vein sampling.

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Section: Discussionsupporting

confidence: 82%

Advanced monoenergetic reconstruction technique in dual-energy computed tomography for evaluation of vascular anatomy before adrenal vein sampling

et al. 2019

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“…The differential diagnosis should include bilateral adrenal hyperplasia and adrenocortical adenoma, the two main causes of PA. According to www.ah.viamedica.pl the guidelines, computed tomography and adrenal vein sampling should be performed as a part of PA subtyping [145,150]. As neither of these can be performed in pregnancy, MRI may be considered to assess adrenal structure, but only in cases where surgical treatment is considered due to uncontrolled BP and potassium levels.…”

Section: Primary Aldosteronism Subtypingmentioning

confidence: 99%

Management of hypertension in pregnancy — prevention, diagnosis, treatment and long-term prognosis. A position statement of the Polish Society of Hypertension, Polish Cardiac Society and Polish Society of Gynaecologists and Obstetricians

Prejbisz¹,

Dobrowolski²,

Kosiński³

et al. 2019

Arterial Hypertension

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Disclaimer: The position statement represent the views of the authors and were produced after careful consideration of the scientific and medical knowledge and the evidence available at the time of their dating. The authors and societies are not responsible in the event of any contradiction, discrepancy, and/or ambiguity between the position statement and any other official recommendations or guidelines issued by the relevant public health authorities, in particular in relation to good use of healthcare or therapeutic strategies. Health professionals are encouraged to take the position statement fully into account when exercising their clinical judgment as well as in the determination and the implementation of preventive, diagnostic, or therapeutic medical strategies. 118 www.ah.viamedica.pl ABPM -ambulatory blood pressure monitoring ACE-I -angiotensin-converting enzyme inhibitor AF -atrial fibrillation AFI -amniotic fluid index AFL -atrial flutter AGA -appropriate for gestational age AHI -apnea hypopnea index AKI -acute kidney injury ALT -alanine transaminase ARB -angiotensin receptor blocker ARR -aldosterone-to-renin ratio AST -aspartate aminotransferase AT -atrial tachycardia BAV -bicuspid aortic valve BMI -body mass index BNP -B-nariuretic peptide BP -blood pressure Bpm -beats per minute BPP -biophysical profile CABG -coronary artery bypass graft CAD -coronary artery disease CKD -chronic kidney disease CNS -central nervous system CoA -coarctation of the aorta CPAP -continuous positive airway pressure CPR -cerebroplacental ratio CTG -cardiotocography CV -cardiovascular DBP -diastolic blood pressure DIC -disseminated intravascular coagulation DM -diabetes mellitus ECMO -extracorporeal membrane oxygenation ECG -electrocardiography EF -ejection fraction ESC -European Society of Cardiology ESH -European Society of Hypertension EVA -early vascular ageing FDA -Food and Drug Administration FHR -foetal heart rate FIGO -International Federation of Gynaecology and Obstetrics FMD -fibromuscular dysplasia FMF -Fetal Medicine Foundation FPS -frame per second GFR -glomerular filtration rate HELLP -hemolysis, elevated liver enzymes, low platelet countuterine growth restriction IVF -in vitro fertilisation LBBB -left bundle branch block LBW -low birth weight LDH -lactate dehydrogenase LQTS -long QT syndrome LVAD -left ventricular assist device LVEF -left ventricular ejection fraction MAP -mean arterial pressure MCA -middle cerebral artery MCS -mechanical circulatory support MDT -multidisciplinary team MRA -mineralocorticoids renceptor antagonist MRAs -mineralocorticoids renceptor antagonists MRI -magnetic resonance imaging NSTEMI -non-ST elevation myocardial infarction NT-BNP -N-terminal pro-BNP NTS -non-stress-test OGTT -oral glucose tolerance test OSA -obstructive sleep apnoea p.o. -per os PA -primary aldosteronism PAPP-A -pregnancy associated placental protein PCI -percutaneous coronary intervention PE -pre-eclampsia PI -pulsatility index PlGF -placental growth factor PPCM -peripartum cardiomyopathy PPGL -pheochromocytoma a...

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“…AVS is recommended as the principal subtyping test [3,42,55]. This method relies on the catheterization of both adrenal veins and the subsequent collection of blood samples from both adrenal veins and the inferior vena cava.…”

Section: Avsmentioning

confidence: 99%

What We Know about and What Is New in Primary Aldosteronism

Ekman,

Grossman,

Dworakowska

2024

IJMS

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Primary aldosteronism (PA), a significant and curable cause of secondary hypertension, is seen in 5–10% of hypertensive patients, with its prevalence contingent upon the severity of the hypertension. The principal aetiologies of PA include bilateral idiopathic hypertrophy (BIH) and aldosterone-producing adenomas (APAs), while the less frequent causes include unilateral hyperplasia, familial hyperaldosteronism (FH) types I-IV, aldosterone-producing carcinoma, and ectopic aldosterone synthesis. This condition, characterised by excessive aldosterone secretion, leads to augmented sodium and water reabsorption alongside potassium loss, culminating in distinct clinical hallmarks: elevated aldosterone levels, suppressed renin levels, and hypertension. Notably, hypokalaemia is present in only 28% of patients with PA and is not a primary indicator. The association of PA with an escalated cardiovascular risk profile, independent of blood pressure levels, is notable. Patients with PA exhibit a heightened incidence of cardiovascular events compared to counterparts with essential hypertension, matched for age, sex, and blood pressure levels. Despite its prevalence, PA remains frequently undiagnosed, underscoring the imperative for enhanced screening protocols. The diagnostic process for PA entails a tripartite assessment: the aldosterone/renin ratio (ARR) as the initial screening tool, followed by confirmatory and subtyping tests. A positive ARR necessitates confirmatory testing to rule out false positives. Subtyping, achieved through computed tomography and adrenal vein sampling, aims to distinguish between unilateral and bilateral PA forms, guiding targeted therapeutic strategies. New radionuclide imaging may facilitate and accelerate such subtyping and localisation. For unilateral adrenal adenoma or hyperplasia, surgical intervention is optimal, whereas bilateral idiopathic hyperplasia warrants treatment with mineralocorticoid antagonists (MRAs). This review amalgamates established and emerging insights into the management of primary aldosteronism.

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A single-centre experience of the implementation of adrenal vein sampling procedure: the impact on the diagnostic work-up in primary aldosteronism

Cited by 5 publications

References 26 publications

Advanced monoenergetic reconstruction technique in dual-energy computed tomography for evaluation of vascular anatomy before adrenal vein sampling

Advanced monoenergetic reconstruction technique in dual-energy computed tomography for evaluation of vascular anatomy before adrenal vein sampling

Management of hypertension in pregnancy — prevention, diagnosis, treatment and long-term prognosis. A position statement of the Polish Society of Hypertension, Polish Cardiac Society and Polish Society of Gynaecologists and Obstetricians

What We Know about and What Is New in Primary Aldosteronism

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