Optimum position of left adrenal vein sampling for subtype diagnosis in primary aldosteronism

Umakoshi, Hironobu; Wada, Norio; Ichijo, Takamasa; Kamemura, Kohei; Matsuda, Yuichi; Fuji, Yuichi; Kai, Tatsuya; Fukuoka, Tatsunari; Sakamoto, Ryuichi; Ogo, Atsushi; Suzuki, Tomoko; Tsuiki, Mika; Naruse, Mitsuhide

doi:10.1111/cen.12847

Cited by 37 publications

(22 citation statements)

References 29 publications

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“…As expected, the SI was significantly lower on the left side, which results from the LAV anatomy that joins the inferior phrenic vein forming a common trunk where the catheter is usually placed and aspirates diluted blood. Previous reports indicated that selective cannulation of the LAV does not provide additional benefit [24,25]. The selectivity indices were remarkably high because all procedures were performed during cosyntropin infusion.…”

Section: Discussionmentioning

confidence: 97%

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

et al. 2017

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A b s t r a c tBackground: Primary aldosteronism is one of the most common causes of secondary hypertension. Adrenal vein sampling (AVS) remains a "gold standard" procedure in differentiation between unilateral (adenoma) and bilateral (hyperplasia) disease. Aim:The aim of this study was to present our single-centre experience in establishing and implementating the AVS procedure. Methods:All patients had primary aldosteronism confirmed in a salt-infusion test. AVS was performed sequentially during a continuous intravenous infusion of cosyntropin and was preceded by multislice contrast-enhanced computed tomography (CT) examination of adrenal glands performed a few weeks before AVS in the majority of patients. AVS was regarded as successful if the ratio of each adrenal vein cortisol to inferior vena cava cortisol levels (selectivity index [SI]) was higher than 3.0. In the case of failure, a second attempt was considered in a few weeks. Patients were divided into four groups according to the order of the procedure by quartiles.Results: Between 31 May, 2012 and 5 May, 2016, AVS was performed in 124 patients (69% males, aged 55.3 ± 10.3 years) and was successful in 120 (96.8%) patients. All failed cases were due to the failure of cannulation of the right adrenal vein. The first-attempt success rate was 94.3% (117 of 124 patients) and increased from 83.9% in the first 31 patients to 100% in the last 31 patients. Similarly, the overall success rate increased from 93.5% to 100%. The right SI was significantly higher than the left one (26.4 vs. 11.0, p < 0.0001). Both indices did not differ across quartiles of patients. No complications occurred during the procedure. Conclusions:The AVS procedure, preceded by adrenal CT, may be implemented into daily diagnostic practice safely with an excellent success rate.

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Section: Discussionmentioning

confidence: 97%

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

et al. 2017

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“…The protocol for AVS has been described previously . Cosyntropin was administered by bolus, by continuous infusion or by bolus and continuous infusion.…”

Section: Methodsmentioning

confidence: 99%

Accuracy of adrenal computed tomography in predicting the unilateral subtype in young patients with hypokalaemia and elevation of aldosterone in primary aldosteronism

Umakoshi

Ogasawara

Takeda

et al. 2018

Clinical Endocrinology

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“…23 Briefly, cosyntropin was given as a bolus infusion before cannulation in 5 centers, and by a bolus infusion followed by a continuous infusion throughout the procedure in the remaining centers. Catheter cannulation was performed using the percutaneous femoral vein approach.…”

Section: Adrenal Venous Samplingmentioning

confidence: 99%

Adrenal Venous Sampling in Patients With Positive Screening but Negative Confirmatory Testing for Primary Aldosteronism

et al. 2016

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Adrenal venous sampling is considered to be the most reliable diagnostic procedure to lateralize aldosterone excess in primary aldosteronism (PA). However, normative criteria have not been established partially because of a lack of data in non-PA hypertensive patients. The aim of the study was to investigate aldosterone concentration and its gradient in the adrenal vein of non-PA hypertensive patients. We retrospectively studied the results of cosyntropin-stimulated adrenal venous sampling in 40 hypertensive patients who showed positive screening testing but negative results in 2 confirmatory tests/captopril challenge test and saline infusion test. Plasma aldosterone concentration, aldosterone/cortisol ratio, its higher/lower ratio (lateralization index) in the adrenal vein with cosyntropin stimulation were measured. Median plasma aldosterone concentration in the adrenal vein was 25 819 pg/mL (range, 5154–69 920) in the higher side and 12 953 (range, 1866–36 190) pg/mL in the lower side ( P <0.001). There was a significant gradient in aldosterone/cortisol ratio between the higher and the lower sides (27.2 [5.4–66.0] versus 17.3 [4.0–59.0] pg/mL per μg/dL; P <0.001) with lateralization index ranging from 1.01 to 3.87. The aldosterone lateralization gradient was between 1 to 2 in 32 patients and 2 to 4 in 8 patients. None of the patients showed lateralization index ≥4. The present study demonstrated that plasma aldosterone concentration in the adrenal veins showed significant variation and lateralization gradient even in non-PA hypertensive patients. Adrenal venous sampling aldosterone lateralization gradients between 2 and 4 should be interpreted with caution in patients with PA because these gradients can be found even in patients with negative confirmatory testing for PA.

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Optimum position of left adrenal vein sampling for subtype diagnosis in primary aldosteronism

Cited by 37 publications

References 29 publications

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

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

Accuracy of adrenal computed tomography in predicting the unilateral subtype in young patients with hypokalaemia and elevation of aldosterone in primary aldosteronism

Adrenal Venous Sampling in Patients With Positive Screening but Negative Confirmatory Testing for Primary Aldosteronism

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