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

Tannai, Hiromitsu; Makita, Kohzoh; Koike, Yuya; Kubo, Hironari; Nakai, Kazuki; Yamazaki, Yuto; Tsurutani, Yuya; Saito, Jun; Matsui, Shinobu; Kakuta, Yukio; Sasano, Hironobu; Nishikawa, Tetsuo

doi:10.1111/cen.14858

Cited by 2 publications

(3 citation statements)

References 33 publications

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“…There are no reports regarding these disadvantages of blood sampling from collateral blood channels. However, for sAVS, there are some reports regarding technical difficulties, time, radiation exposure, costs, and contrast load compared with cAVS ( 6 , 11 , 12 , 13 ). To acquire the procedure of sAVS, even experienced angiographers need training with learning curve ( 12 , 13 ).…”

Section: Discussionmentioning

confidence: 99%

“…However, for sAVS, there are some reports regarding technical difficulties, time, radiation exposure, costs, and contrast load compared with cAVS ( 6 , 11 , 12 , 13 ). To acquire the procedure of sAVS, even experienced angiographers need training with learning curve ( 12 , 13 ). sAVS take longer time than cAVS, although sAVS are reported to be performed within a reasonable time (58–130 min) by highly skilled angiographers ( 6 ).…”

Section: Discussionmentioning

confidence: 99%

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High aldosterone levels in the renal capsular vein from the left aldosterone-producing adenoma on adrenal venous sampling

Hirose,

Tannai,

Nakai

et al. 2023

Endocrinology, Diabetes &Amp; Metabolism Case Reports

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Summary A 42-year-old female patient was referred to our hospital with hypertension and hypokalemia and was diagnosed with primary aldosteronism. Dynamic contrast-enhanced computed tomography images revealed a 13-mm nodule on the lateral segment of the left adrenal gland and a fine venous connection between the nodule and the prominent renal capsular vein running nearby. The venograms in the left lateral tributary with a microcatheter confirmed alternative drainage to the left renal capsular vein during adrenal venous sampling, and the left renal capsular vein sampling was added. The patient was diagnosed with a left aldosterone-producing adenoma (APA) using the lateralization index (48.3) and a higher plasma aldosterone concentration (PAC) of the left lateral tributary (66 700 pg/mL) than other tributary samples after adrenocorticotropic hormone stimulation. Furthermore, markedly higher PAC (224 000 pg/mL) was observed in the left renal capsular vein blood than in the left adrenal central vein (45 000 pg/mL) and tributaries, confirming the diagnosis. Laparoscopic left partial adrenalectomy and following histopathological analysis revealed a CYP11B2-positive adrenocortical adenoma. Complete clinical and biochemical success for primary aldosteronism was achieved after 6 months. Direct evidence of APA blood venous drainage into the renal capsular vein has been demonstrated. Sampling from an alternative drainage pathway could be beneficial for APA diagnosis if such APA blood drainage is assumed. Learning points Aldosterone-producing adenomas may drain blood into an alternative pathway but for the adrenal vein. The presence of alternative venous drainage could be assumed by contrast-enhanced computed tomography or venogram during adrenal venous sampling. Sampling in the alternative drainage veins and demonstrating elevated aldosterone levels could help in diagnosing aldosterone-producing adenoma.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

High aldosterone levels in the renal capsular vein from the left aldosterone-producing adenoma on adrenal venous sampling

Hirose,

Tannai,

Nakai

et al. 2023

Endocrinology, Diabetes &Amp; Metabolism Case Reports

Self Cite

View full text Add to dashboard Cite

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“…Because all these indices are affected by the PAC measurement method, it is not clear what the cut-off value would be if measurements by non-RIA methods, such as CLEIA, were used. In some institutions, including our hospital, we have conducted segmental AVS (sAVS) by collecting blood samples from multiple tributary veins in each adrenal gland to detect the exact location of the PA causative lesions and have reported its usefulness [7][8][9][10]. In sAVS, the absolute PAC value in adrenal venous blood after adrenocorticotropic hormone loading is used to determine aldosterone excess, and 14,000 pg/mL has been used as the cut-off value [3,5,7].…”

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confidence: 99%

Adrenal venous sampling criteria for chemiluminescent enzyme immunoassay as a preferable alternative to radioimmunoassay in primary aldosteronism

Nakai,

Tsurutani,

Irie

et al. 2024

Endocr J

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Plasma aldosterone concentration (PAC) was routinely measured using radioimmunoassay (RIA); however, the RIA kit was discontinued in March 2021 in Japan. This study examined PAC conversion in adrenal venous sampling (AVS) and AVS criteria when measured using chemiluminescent enzyme immunoassay (CLEIA). PAC of 415 adrenal venous blood samples from AVS (including segmental AVS) of 63 patients with primary aldosteronism was measured using RIA (Spac-S aldosterone kit; Fujirebio Inc.) and CLEIA (Lumipulse Presto Aldosterone; Fujirebio Inc.). PAC of 70 AVS samples was also measured using liquid chromatography-mass spectrometry (LC-MS/MS, ASKA Pharma Medical Co., Ltd.). PAC conversion formulas were determined for each AVS sample assay. PAC measured using CLEIA was significantly correlated with that measured using RIA (correlation coefficient = 0.971). The PAC conversion formula was PAC (CLEIA) = PAC (RIA) × 0.772 -1,199 pg/mL. The PAC of 14,000 pg/mL in RIA was equivalent to 9,613 pg/mL in CLEIA. PAC measured using CLEIA was also correlated with that measured using LC-MS/MS, and the PAC conversion formula was PAC (CLEIA, pg/mL) = 0.97 × PAC (LC-MS/MS, pg/mL) + 211. The inter-assay coefficient of variability (CV) was 1.1-1.3% and intra-assay CV was 1.0-1.7%, measured using CLEIA. The PAC conversion formula for AVS samples was obtained using CLEIA and RIA, and the conversion formula was different from that for peripheral blood. PAC values measured by CLEIA showed preferable accuracy and high concordance with those measured by LC-MS/MS, even in AVS samples. The study outcomes are useful for interpreting AVS results using non-RIA measurement methods.

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

Cited by 2 publications

References 33 publications

High aldosterone levels in the renal capsular vein from the left aldosterone-producing adenoma on adrenal venous sampling

High aldosterone levels in the renal capsular vein from the left aldosterone-producing adenoma on adrenal venous sampling

Adrenal venous sampling criteria for chemiluminescent enzyme immunoassay as a preferable alternative to radioimmunoassay in primary aldosteronism

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