Anatomical basis of radiodiagnosis of the adrenal gland

Miekoś, E

doi:10.1007/bf02081960

Cited by 9 publications

(6 citation statements)

References 7 publications

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“…The right and left adrenals typically have three tributary veins 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. Very few connections have been identified between these TVs 12 . Therefore, ssAVS enables the identification of a specific adrenal segment(s) not producing aldosterone autonomously within an affected adrenal, thereby allowing bilateral adrenal surgery to be performed on bilateral PA while sparing unaffected adrenal segment(s).…”

Section: Introductionmentioning

confidence: 99%

A Novel Method: Super-selective Adrenal Venous Sampling

Makita

Nishimoto

Kiriyama-Kitamoto

et al. 2017

JoVE

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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.

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Section: Introductionmentioning

confidence: 99%

A Novel Method: Super-selective Adrenal Venous Sampling

Makita

Nishimoto

Kiriyama-Kitamoto

et al. 2017

JoVE

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“…Recent literature reports that SSA can branch profusely, such that their number could range from 1 to 30 from one or more sources ( Table 3 ) [ 3 , 12 , 42 ]. In addition, the commonest branching pattern in most studies was reported as 4 to 8 arteries [ 3 , 4 , 12 , 43 - 45 ]. On dissecting the fetal specimens, few authors concluded after that the number of MSA ranges mostly between 1 to 3 [ 3 , 4 ].…”

Section: Discussionmentioning

confidence: 99%

“…Most relevent findings Greeff et al [27] Dutta [5] Manso and DiDio [12] Bianchi and Ferrari [4] Toni et al [15] Meikos [43] Mazza [44] Levi [45] Research chronology till present day SSA was reported to be absent in few cases. AA and RA were most common origin of MSA and frequently absent bilaterally.…”

Section: Name Of Researchermentioning

confidence: 99%

Prevalence and clinical relevance of the anatomical variations of suprarenal arteries: a review

2022

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The suprarenal arteries are arising from three sources: superior suprarenal artery, middle suprarenal artery, and inferior suprarenal artery. Variations in the arterial supply of the suprarenal glands in respect to origin and number are quite common and very frequently reported. The most common variation noted is in the inferior suprarenal artery followed by the middle suprarenal artery and the least common variations were observed in the superior suprarenal artery. Arteriogram of the inferior suprarenal artery is crucial in suprarenal tumour diagnosis but variation in the branching pattern and multiplicity of these arteries can cause hindrance in arteriography. The absence of middle suprarenal artery was seen to be associated with increased number of the inferior suprarenal artery. Variation in the multiplicity of arteries was observed more frequently in the inferior suprarenal artery and middle suprarenal artery which was more on the right side in most of the studies. Also, the variation in suprarenal arteries was often correlated to variations in inferior phrenic and gonadal arteries. The variations were observed to be more common on the left side therefore right adrenalectomy should be preferred over the left one. The loop formed by the inferior suprarenal artery around the right renal vein can cause venous obstruction. These variations of suprarenal vasculature are explained on the developmental basis, and prior knowledge of such variants is crucial for nephrologists to ensure minimum blood loss while performing laparoscopic adrenalectomy especially for large adrenal tumours and pheochromocytoma where the duration of surgery exceeds the usual.

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“…In sAVS, high aldosterone levels from one APA may be observed in not one, but two, and rarely three segments 7 due to potential inter-tributary anastomoses. 32 c CT-detected nodule was negative for CYP11B2, and another smaller nodule was positive for CYP11B2.…”

Section: Discussionmentioning

confidence: 93%

“…This result may be due to contamination of APA blood in the non‐APA blood drainer. In sAVS, high aldosterone levels from one APA may be observed in not one, but two, and rarely three segments 7 due to potential inter‐tributary anastomoses 32 . This contamination is especially likely if the nodules are relatively close to each other.…”

Section: Discussionmentioning

confidence: 99%

Node‐by‐node diagnosis for multiple ipsilateral nodules by segmental adrenal venous sampling in primary aldosteronism

Tannai

Makita²,

Koike

et al. 2022

Clinical Endocrinology

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Objectives In patients with primary aldosteronism (PA), multiple adrenocortical nodules may be present on the surgical side. The aim of this study was to clarify the pathological diagnosis and the node‐by‐node diagnostic capability of segmental adrenal venous sampling (sAVS). Design Retrospective study. Patients A total of 162 patients who underwent adrenalectomy following sAVS were studied. Measurements Multiple nodules on the surgical side were extracted while referring to contrast‐enhanced computed tomography images. We also performed a detailed histopathological analysis of the resected specimens from patients undergoing sAVS, which included immunohistochemistry for CYP11B2. Results In 11 (6.8%) patients, two to three nodules were detected on the surgical side. All patients were diagnosed by sAVS with at least one aldosterone‐producing adenoma (APA) for localized aldosterone elevation in tributaries. Seven patients showed a lateralization index value of ≥4 after ACTH stimulation. Histopathologically and clinically, two patients had two or three CYP11B2‐positive APAs, and the other nine patients both APAs and non‐APAs. The positive predictive value of the most suspected APA, that is, the drainer that showed the highest aldosterone level by sAVS, was 11/11 (100%, 95% confidence interval [CI]: 71.5%–100%), while that for the second and third suspected APA was 3/7 (42.9%, 95% CI: 9.9%–81.6%), and they were significantly different (p = .01). Further, the positive predictive value of non‐APA was 4/4 (100%, 95% CI: 39.8%–100%). Conclusions The sAVS could correctly diagnose the aldosterone production in multiple ipsilateral adrenal nodules.

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Anatomical basis of radiodiagnosis of the adrenal gland

Cited by 9 publications

References 7 publications

A Novel Method: Super-selective Adrenal Venous Sampling

A Novel Method: Super-selective Adrenal Venous Sampling

Prevalence and clinical relevance of the anatomical variations of suprarenal arteries: a review

Node‐by‐node diagnosis for multiple ipsilateral nodules by segmental adrenal venous sampling in primary aldosteronism

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