Localization of Aldosterone-Producing Adenoma: Venous Sampling in Primary Aldosteronism.

Abstract

Adrenal venous sampling of blood was performed for nine patients with aldosterone-producing adenoma (APA). Measurement of adrenal venous aldosterone is useful for localization of APA but difficult, because catheterization of the right adrenal vein is not easy, and the blood is diluted by nonadrenal flow. To solve these problems, levels of aldosterone (A; ng/dl) and cortisol (C; inferior vena cava (IV C), and the LAV A/C and (LAV A/C)/(IVC A/C) ratios were calculated.These ratios were also obtained for 16 patients with essential hypertension.

Low Plasma 19-Hydroxyandrostenedione Levels in Patients with Aldosterone-Producing Adenoma.

“…PAC and plasma cortisol levels in the patient were 2,600 pg/ml and 6.3 µg/dl in the left adrenal vein and 105 pg/ml and 2.1 µg/dl in the IVC, respectively. The ratio (410) of PAC (pg/ml) to plasma cortisol (µg/dl) in the left adrenal vein in this patient was compatible with that in patients with left APA according to the criteria of Iwaoka et al (a ratio above 50 in the left adrenal vein indicates the presence of left APA) [13]. All the patients had high PAC (more than 138 pg/ml) and low PRA (less than 0.4 ng/ml/h).…”

Variant of Pre-Clinical Cushing's Syndrome: Hypertension and Hypokalemia Associated with Normoreninemic Normoaldosteronism.

“…However, a markedly lower aldosterone level in the adrenal vein contralateral to the tumor was inconsistent with non-suppressed PRA. According to previous results of an adrenal venous sampling without ACTH infusion in patients with essential hypertension (29), the plasma aldosterone level in the adrenal vein ranges from about 600 to 33,000 pmol/l. In primary aldosteronism in this report, the plasma aldosterone level in the tumor-sided adrenal vein ranged from about 13,000 to 66,000 pmol/l.…”

Ultrasonography in the Diagnosis of Aldosterone-Producing Adenoma: Is It Useful?

“…Imaging examinations are imperative not only in the differential diagnosis of primary aldosteronism due to APA and idiopathic hyperaldosteronism but also in tumor localization. Although CT, adrenal scintigraphy (12,13) and adrenal venous sampling (2,14,15) Ultrasonography of Aldosteronoma study (16) the majority (87%) of APA were less than 2.5cm in diameter, and the adrenal glands are located deep within the rib-cage in the retroperitoneal fatty tissue. Delineation of small adrenal tumors by US is therefore not easy (1,5).…”

“…Computed axial tomography (CT) is generally con sidered to be superior to ultrasonography (US) in the localization diagnosis of small adrenal tumors (1)(2)(3). However, in Japan, there has recently been an increase in the use of CT, so that a patient must wait one to two weeks before examination.…”

“…Repeat examinations can be done immediately as early as one desires. However, the usefulness of US to detect small adrenal tumors remains controversial (1)(2)(3)(4)(5). Recently, this problem has been offset with the improvement in resolution, thereby increasing the detection rate even for small adrenal tumors (3,4,6,7).…”