This Article Full Text Full Text (PDF) Submit a related Letter to the Editor Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Reprints, Permissions and Rights Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Rossi, G. P. Articles by Pessina, A. C. Search for Related Content PubMed PubMed Citation Articles by Rossi, G. P. Articles by Pessina, A. C.

Identification of the Etiology of Primary Aldosteronism with Adrenal Vein Sampling in Patients with Equivocal Computed Tomography and Magnetic Resonance Findings: Results in 104 Consecutive Cases

Departments of Clinical and Experimental Medicine and Medical Sciences, Diagnostics and Special Therapeutics (M.C.-C., G.P.F.), University of Padova, 35126 Padova, Italy

Address all correspondence and requests for reprints to: G. P. Rossi, M.D., F.A.C.C., Clinica Medica 4, Hypertension Unit, University Hospital, via Giustiniani 2, 35126 Padova, Italy. E-mail: gprossi{at}ux1.unipd.it

The objectives of this study were to investigate the usefulness of adrenal vein sampling in identifying the etiology of primary aldosteronism (PA) in patients with equivocal CT and MR findings. Between 1990 and 1999, 104 referred hypertensive patients (45 women and 59 men, aged 49.6 ± 11.6 yr) were diagnosed to have PA with inconclusive computed tomography scan and magnetic resonance results, based on established criteria. Adrenal vein sampling (AVS) for measurement of plasma aldosterone (A) and cortisol (C) levels was performed in all. Selectivity of AVS was assessed by the ratio between C levels in each adrenal vein and in the infrarenal inferior vena cava plasma (C_side/C_IVC). A receiver operator characteristics analysis was carried out to establish 1) the best AVS-derived index, 2) the degree of selectivity that could provide an accurate diagnosis, and 3) whether a correct diagnosis could be made from a unilaterally selective AVS.

An aldosterone-producing adenoma (average diameter, 12.2 ± 0.08 mm) was eventually diagnosed in 41 patients (39.4%) and was excluded in the rest. Adrenal vein rupture leading to partial adrenal loss occurred in 1 patient (0.9% complication rate). By assuming a cut-off value of C_side/C_IVC 1.1, AVS was selective in 85.7% and 94.1% of cases on the right and left sides, respectively, and bilaterally in 80.6% of cases. Of all AVS-derived indexes, the A/C of one over the A/C contralateral side [(A/C)_side/(A/C)_{contralateral side}] furnished the best diagnostic accuracy. With a bilaterally selective AVS, a value of (A/C)_side/(A/C)_{contralateral side} 2 provided a conclusive etiological diagnosis of PA in 79.7% of cases. At variance, no accurate diagnosis could be made from unilaterally selective AVS.

AVS was feasible and safe in most PA patients with inconclusive computed tomography and magnetic resonance scans. When bilaterally selective (i.e. C_side/C_IVC 1.1) a ratio of (A/C)_side/(A/C)_control 2 provided the best compromise of sensitivity and false positive rate for lateralization of the etiology of PA.

This article has been cited by other articles:

				J. Ceral, M. Solar, A. Krajina, M. Ballon, P. Suba, and J. Cap Adrenal venous sampling in primary aldosteronism: a low dilution of adrenal venous blood is crucial for a correct interpretation of the results Eur. J. Endocrinol., January 1, 2010; 162(1): 101 - 107. [Abstract] [Full Text] [PDF]

				G. P. Rossi, T. M. Seccia, G. Palumbo, A. Belfiore, G. Bernini, G. Caridi, G. Desideri, B. Fabris, C. Ferri, G. Giacchetti, et al. Within-Patient Reproducibility of the Aldosterone:Renin Ratio in Primary Aldosteronism Hypertension, January 1, 2010; 55(1): 83 - 89. [Abstract] [Full Text] [PDF]

				R.-F. Yen, V.-C. Wu, K.-L. Liu, M.-F. Cheng, Y.-W. Wu, S.-C. Chueh, W.-C. Lin, K.-D. Wu, K.-Y. Tzen, C.-C. Lu, et al. 131I-6{beta}-Iodomethyl-19-Norcholesterol SPECT/CT for Primary Aldosteronism Patients with Inconclusive Adrenal Venous Sampling and CT Results J. Nucl. Med., October 1, 2009; 50(10): 1631 - 1637. [Abstract] [Full Text] [PDF]

				D. Miotto, R. De Toni, G. Pitter, T. M. Seccia, R. Motta, M. Vincenzi, G. Feltrin, and G. P. Rossi Impact of Accessory Hepatic Veins on Adrenal Vein Sampling for Identification of Surgically Curable Primary Aldosteronism Hypertension, October 1, 2009; 54(4): 885 - 889. [Abstract] [Full Text] [PDF]

				M. Tanemoto, E. Mishima, Y. Takeuchi, and T. Abe Adrenocorticotropic Hormone Stimulation During Adrenal Vein Sampling Hypertension, September 1, 2009; 54(3): e23 - e23. [Full Text] [PDF]

				N. Sukor, R. D. Gordon, Y. K. Ku, M. Jones, and M. Stowasser Role of Unilateral Adrenalectomy in Bilateral Primary Aldosteronism: A 22-Year Single Center Experience J. Clin. Endocrinol. Metab., July 1, 2009; 94(7): 2437 - 2445. [Abstract] [Full Text] [PDF]

				T. M. Seccia, D. Miotto, R. De Toni, G. Pitter, F. Mantero, A. C. Pessina, and G. P. Rossi Adrenocorticotropic Hormone Stimulation During Adrenal Vein Sampling for Identifying Surgically Curable Subtypes of Primary Aldosteronism: Comparison of 3 Different Protocols Hypertension, May 1, 2009; 53(5): 761 - 766. [Abstract] [Full Text] [PDF]

				G. Giacchetti, V. Ronconi, S. Rilli, M. Guerrieri, F. Turchi, and M. Boscaro Small tumor size as favorable prognostic factor after adrenalectomy in Conn's adenoma Eur. J. Endocrinol., April 1, 2009; 160(4): 639 - 646. [Abstract] [Full Text] [PDF]

				M. Tanemoto, T. Suzuki, M. Abe, T. Abe, and S. Ito Physiologic variance of corticotropin affects diagnosis in adrenal vein sampling Eur. J. Endocrinol., March 1, 2009; 160(3): 459 - 463. [Abstract] [Full Text] [PDF]

				L. Giuliani, L. Lenzini, M. Antonello, E. Aldighieri, A. S. Belloni, A. Fassina, C. Gomez-Sanchez, and G. P. Rossi Expression and Functional Role of Urotensin-II and Its Receptor in the Adrenal Cortex and Medulla: Novel Insights for the Pathophysiology of Primary Aldosteronism J. Clin. Endocrinol. Metab., February 1, 2009; 94(2): 684 - 690. [Abstract] [Full Text] [PDF]

				J. W. Funder, R. M. Carey, C. Fardella, C. E. Gomez-Sanchez, F. Mantero, M. Stowasser, W. F. Young Jr., and V. M. Montori Case Detection, Diagnosis, and Treatment of Patients with Primary Aldosteronism: An Endocrine Society Clinical Practice Guideline J. Clin. Endocrinol. Metab., September 1, 2008; 93(9): 3266 - 3281. [Abstract] [Full Text] [PDF]

				G. P. Rossi, M. Bolognesi, D. Rizzoni, T. M. Seccia, A. Piva, E. Porteri, G. A.M. Tiberio, S. M. Giulini, E. Agabiti-Rosei, and A. C. Pessina Vascular Remodeling and Duration of Hypertension Predict Outcome of Adrenalectomy in Primary Aldosteronism Patients Hypertension, May 1, 2008; 51(5): 1366 - 1371. [Abstract] [Full Text] [PDF]

				V.C. Wu, S.C. Chueh, H.W. Chang, W.C. Lin, K.L. Liu, H.Y. Li, Y.H. Lin, K.D. Wu, and B.S. Hsieh Bilateral aldosterone-producing adenomas: differentiation from bilateral adrenal hyperplasia QJM, January 1, 2008; 101(1): 13 - 22. [Abstract] [Full Text] [PDF]

				G. P. Rossi, A. Belfiore, G. Bernini, G. Desideri, B. Fabris, C. Ferri, G. Giacchetti, C. Letizia, M. Maccario, F. Mallamaci, et al. Comparison of the Captopril and the Saline Infusion Test for Excluding Aldosterone-Producing Adenoma Hypertension, August 1, 2007; 50(2): 424 - 431. [Abstract] [Full Text] [PDF]

				S. M. Patel, R. K. Lingam, T. I. Beaconsfield, T. L. Tran, and B. Brown Role of Radiology in the Management of Primary Aldosteronism RadioGraphics, July 1, 2007; 27(4): 1145 - 1157. [Abstract] [Full Text] [PDF]

				O. Vonend, C. Altenhenne, N. J. Buchner, G. Dekomien, C. Maser-Gluth, S. M. Weiner, L. Sellin, S. Hofebauer, J. T. Epplen, and L. C. Rump A German family with glucocorticoid-remediable aldosteronism Nephrol. Dial. Transplant., April 1, 2007; 22(4): 1123 - 1130. [Abstract] [Full Text] [PDF]

				G. P. Rossi, G. Bernini, C. Caliumi, G. Desideri, B. Fabris, C. Ferri, C. Ganzaroli, G. Giacchetti, C. Letizia, M. Maccario, et al. A Prospective Study of the Prevalence of Primary Aldosteronism in 1,125 Hypertensive Patients J. Am. Coll. Cardiol., December 5, 2006; 48(11): 2293 - 2300. [Abstract] [Full Text] [PDF]

				G. P. Rossi, G. Bernini, G. Desideri, B. Fabris, C. Ferri, G. Giacchetti, C. Letizia, M. Maccario, M. Mannelli, M.-J. Matterello, et al. Renal Damage in Primary Aldosteronism: Results of the PAPY Study Hypertension, August 1, 2006; 48(2): 232 - 238. [Abstract] [Full Text] [PDF]

				Y. W. Novitsky, K. W. Kercher, A. G. Harrell, and B. T. Heniford Laparoscopic Expertise Increases Hospital Volume of Adrenal Surgery Surgical Innovation, June 1, 2006; 13(2): 109 - 114. [Abstract] [PDF]

				F. E. Nwariaku, B. S. Miller, R. Auchus, S. Holt, L. Watumull, B. Dolmatch, S. Nesbitt, W. Vongpatanasin, R. Victor, F. Wians, et al. Primary Hyperaldosteronism: Effect of Adrenal Vein Sampling on Surgical Outcome Arch Surg, May 1, 2006; 141(5): 497 - 503. [Abstract] [Full Text] [PDF]

				P. Milliez, X. Girerd, P.-F. Plouin, J. Blacher, M. E. Safar, and J.-J. Mourad Evidence for an increased rate of cardiovascular events in patients with primary aldosteronism J. Am. Coll. Cardiol., April 19, 2005; 45(8): 1243 - 1248. [Abstract] [Full Text] [PDF]

				Y. Takeuchi, H. Suzuki, S. Ogura, R. Imai, Y. Yamazaki, T. Yamashita, Y. Miyamoto, H. Okazaki, K. Nakamura, K. Nakahara, et al. Venous Sampling for Fibroblast Growth Factor-23 Confirms Preoperative Diagnosis of Tumor-Induced Osteomalacia J. Clin. Endocrinol. Metab., August 1, 2004; 89(8): 3979 - 3982. [Abstract] [Full Text] [PDF]

				P.-F. Plouin, L. Amar, and G. Chatellier Trends in the prevalence of primary aldosteronism, aldosterone-producing adenomas, and surgically correctable aldosterone-dependent hypertension Nephrol. Dial. Transplant., April 1, 2004; 19(4): 774 - 777. [Full Text] [PDF]

				R. Coutant, H. Maurey, S. Rouleau, E. Mathieu, P. Mercier, J. M. Limal, and A. Le Bouil Defect in Epinephrine Production in Children with Craniopharyngioma: Functional or Organic Origin? J. Clin. Endocrinol. Metab., December 1, 2003; 88(12): 5969 - 5975. [Abstract] [Full Text] [PDF]

				E. A. Espiner, D. G. Ross, T. G. Yandle, A. M. Richards, and P. J. Hunt Predicting Surgically Remedial Primary Aldosteronism: Role of Adrenal Scanning, Posture Testing, and Adrenal Vein Sampling J. Clin. Endocrinol. Metab., August 1, 2003; 88(8): 3637 - 3644. [Abstract] [Full Text] [PDF]

				W. F. Young Jr. Minireview: Primary Aldosteronism--Changing Concepts in Diagnosis and Treatment Endocrinology, June 1, 2003; 144(6): 2208 - 2213. [Abstract] [Full Text] [PDF]

				G. P. Rossi, C. Ganzaroli, M. Cesari, A. Maresca, M. Plebani, G. G. Nussdorfer, and A. C. Pessina Endothelin receptor blockade lowers plasma aldosterone levels via different mechanisms in primary aldosteronism and high-to-normal renin hypertension Cardiovasc Res, January 1, 2003; 57(1): 277 - 283. [Abstract] [Full Text] [PDF]

				G. P. Rossi, V. Di Bello, C. Ganzaroli, A. Sacchetto, M. Cesari, A. Bertini, D. Giorgi, R. Scognamiglio, M. Mariani, and A. C. Pessina Excess ldosterone Is Associated With Alterations of Myocardial Texture in Primary Aldosteronism Hypertension, July 1, 2002; 40(1): 23 - 27. [Abstract] [Full Text] [PDF]