TY - JOUR
T1 - Intra-Adrenal aldosterone secretion
T2 - Segmental adrenal venous sampling for localization
AU - Satani, Nozomi
AU - Ota, Hideki
AU - Seiji, Kazumasa
AU - Morimoto, Ryo
AU - Kudo, Masataka
AU - Iwakura, Yoshitsugu
AU - Ono, Yoshikiyo
AU - Nezu, Masahiro
AU - Omata, Kei
AU - Ito, Sadayoshi
AU - Satoh, Fumitoshi
AU - Takase, Kei
PY - 2016/1
Y1 - 2016/1
N2 - Purpose: To use segmental adrenal venous sampling (AVS) (S-AVS) of effluent tributaries (a version of AVS that, in addition to helping identify aldosterone hypersecretion, also enables the evaluation of intra-Adrenal hormone distribution) to detect and localize intra-Adrenal aldosterone secretion. Materials and Methods: The institutional review board approved this study, and all patients provided informed consent. S-AVS was performed in 65 patients with primary aldosteronism (34 men; mean age, 50.9 years 6 11 [standard deviation]). A microcatheter was inserted in first-degree tributary veins. Unilateral aldosterone hypersecretion at the adrenal central vein was determined according to the lateralization index after cosyntropin stimulation. Excess aldosterone secretion at the adrenal tributary vein was considered to be present when the aldosterone/cortisol ratio from this vein exceeded that from the external iliac vein; suppressed secretion was indicated by the opposite pattern. Categoric variables were expressed as numbers and percentages; continuous variables were expressed as means 6 standard errors of the mean. Results: The AVS success rate, indicated by a selectivity index of 5 or greater, was 98% (64 of 65). The mean numbers of sampled tributaries on the left and right sides were 2.11 and 1.02, respectively. The following diagnoses were made on the basis of S-AVS results: unilateral aldosterone hypersecretion in 30 patients, bilateral hypersecretion without suppressed segments in 22 patients, and bilateral hypersecretion with at least one suppressed segment in 12 patients. None of the patients experienced severe complications. Conclusion: S-AVS could be used to identify heterogeneous intra-Adrenal aldosterone secretion. Patients who have bilateral aldosterone-producing adenomas can be treated with adrenal-sparing surgery or other minimally invasive local therapies if any suppressed segment is identified at S-AVS.
AB - Purpose: To use segmental adrenal venous sampling (AVS) (S-AVS) of effluent tributaries (a version of AVS that, in addition to helping identify aldosterone hypersecretion, also enables the evaluation of intra-Adrenal hormone distribution) to detect and localize intra-Adrenal aldosterone secretion. Materials and Methods: The institutional review board approved this study, and all patients provided informed consent. S-AVS was performed in 65 patients with primary aldosteronism (34 men; mean age, 50.9 years 6 11 [standard deviation]). A microcatheter was inserted in first-degree tributary veins. Unilateral aldosterone hypersecretion at the adrenal central vein was determined according to the lateralization index after cosyntropin stimulation. Excess aldosterone secretion at the adrenal tributary vein was considered to be present when the aldosterone/cortisol ratio from this vein exceeded that from the external iliac vein; suppressed secretion was indicated by the opposite pattern. Categoric variables were expressed as numbers and percentages; continuous variables were expressed as means 6 standard errors of the mean. Results: The AVS success rate, indicated by a selectivity index of 5 or greater, was 98% (64 of 65). The mean numbers of sampled tributaries on the left and right sides were 2.11 and 1.02, respectively. The following diagnoses were made on the basis of S-AVS results: unilateral aldosterone hypersecretion in 30 patients, bilateral hypersecretion without suppressed segments in 22 patients, and bilateral hypersecretion with at least one suppressed segment in 12 patients. None of the patients experienced severe complications. Conclusion: S-AVS could be used to identify heterogeneous intra-Adrenal aldosterone secretion. Patients who have bilateral aldosterone-producing adenomas can be treated with adrenal-sparing surgery or other minimally invasive local therapies if any suppressed segment is identified at S-AVS.
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U2 - 10.1148/radiol.2015142159
DO - 10.1148/radiol.2015142159
M3 - Article
C2 - 26147784
AN - SCOPUS:84952883994
VL - 278
SP - 265
EP - 274
JO - Radiology
JF - Radiology
SN - 0033-8419
IS - 1
ER -