Role of Venous Sampling in the Diagnosis of Endocrine Disorders

England, Ryan W.; Geer, Eliza B.; Deipolyi, Amy R.

doi:10.3390/jcm7050114

Cited by 12 publications

(7 citation statements)

References 62 publications

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“…AVS is used to localize and lateralize aldosterone hypersecretion. It is a highly specific procedure and requires high technical expertise albeit with varying success rates, thus rendering it not widely available [17]. Once lateralization is confirmed and consistent with the presence of an adenoma, surgery can proceed and patient can potentially be cured.…”

Section: Discussionmentioning

confidence: 99%

The Invisible Evil Twin of an Adrenal Adenoma

Mohamad

Shah

Zainordin

et al. 2019

JCHS

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Primary aldosteronism (PA) causes a persistently elevated blood pressure (BP) due to excessive release of the hormone aldosterone from the adrenal glands. Classically, it is called Conn’s syndrome and is described as the triad of hypertension and hypokalemia with the presence of unilateral adrenal adenoma. It can be cured with surgical resection of the aldosterone-secreting adenoma leading to resolution of hypertension, hypokalemia and increased cardiovascular risk associated with hyperaldosteronism. We present a case of a man with previous ischemic heart disease (IHD) who presented with resistant hypertension. Investigations for secondary causes of hypertension revealed an elevated aldosterone level and saline suppression test confirmed the diagnosis of PA. Radiological examination revealed a left adrenal adenoma and a normal right adrenal gland. However, adrenal venous sampling showed lateralization of aldosterone secretion towards the right. He subsequently underwent a laparoscopic right adrenalectomy which improved his BP control promptly. This case highlights the importance of recognizing the need to investigate for secondary causes of hypertension. It also underscores the importance of dynamic tests, which may not be easily accessible to most clinicians but should pursue, to allow a definitive diagnosis and effective treatment.

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Section: Discussionmentioning

confidence: 99%

The Invisible Evil Twin of an Adrenal Adenoma

Mohamad

Shah

Zainordin

et al. 2019

JCHS

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“…Die NNVBE ist ein etabliertes Verfahren und stellt den Goldstandard zur Detektion einer unilateralen oder bilateralen Erkrankung der Nebennieren dar [19,20]. Darüber hinaus stellt die Abklärung eines ACTH-unabhängigen Hyperkortisolismus (adrenales Cushing-Syndrom) eine weitere Indikation zur NNVBE dar [21].…”

Section: Selektive Nebennierenvenenblutentnahme (Nnvbe) Indikationunclassified

“…In addition, the diagnosis of ACTH-independent hypercortisolism (adrenal Cushing syndrome) is another indication for AVS [21].…”

Section: Indicationsmentioning

confidence: 99%

Update: Selective adrenal venous sampling (AVS) – Indication, technique, and significance

Loberg

Antoch

Stegbauer

et al. 2020

Rofo

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Background Primary aldosteronism (PA) is the most common detectable cause of secondary hypertension. The majority of patients have either an adrenal aldosterone-producing adenoma (APA) or bilateral adrenal hyperplasia (BAH) demanding different therapeutic approaches. Screening tests and imaging cannot reliably distinguish between a unilateral or bilateral PA. Methods This review article gives an overview concerning etiology, diagnostics, and therapeutic options of PA, and reviews the indication, the technique, and relevance of selective adrenal venous sampling (AVS) in the context of the current literature and the authors’ experience. Results AVS can verify or exclude a unilaterally dominated secretion with a high success rate. Patients with PA and a unilateral APA can be treated curatively by adrenalectomy. Conclusions AVS is an established diagnostic examination for differentiation of unilateral from bilateral adrenal disease in patients with PA. Key Points: Citation Format

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“…parathormone level from the subclavian vessels. Whilst this has been proven to be the most sensitive test for ectopic or missed lesions, its invasive nature, average procedure time of 90 min [12] and inherent risks render it less desirable as a tool for initial investigations [13].…”

Section: Parathyroid Venous Samplingmentioning

confidence: 99%