1
|
Tannai H, Makita K, Nakai K, Sato Y, Tsurutani Y, Saito J, Matsui S, Nishikawa T. Differences between left adrenal vein sampling sites revealed with segmental sampling in primary aldosteronism. Br J Radiol 2023; 96:20220766. [PMID: 37660370 PMCID: PMC10607387 DOI: 10.1259/bjr.20220766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 08/15/2023] [Accepted: 08/21/2023] [Indexed: 09/05/2023] Open
Abstract
OBJECTIVES To clarify the differences between two left sampling sites (left adrenal central vein [LCV] and common trunk [CMT], conjunction with LCV and inferior phrenic vein) and their impact on adrenal venous sampling (AVS) in primary aldosteronism by analyzing the results of segmental AVS (sAVS). METHODS We retrospectively analyzed a final cohort of 432 patients who underwent cosyntropin-stimulated sAVS from 2017 to 2020. Hormone levels in the LCV and the CMT were compared. Subtype diagnosis was based on the lateralization index with LCV and CMT sampling (a cutoff value of 4) and sAVS after excluding patients with a selectivity index (SI) <3. RESULTS Compared with the LCV, CMT sampling showed significantly lower aldosterone and cortisol levels and a higher proportion of cases with an SI of <3 (2.8% vs 0.5%, p = 0.025) and <5 (6.9% vs 0.5%, p < 0.001), while the aldosterone-to-cortisol ratio and the lateralization index were not significantly different. Subtyping of both sites was concordant in 94.7% (393/415) and discordant in the remainder, which included left and right aldosterone-producing adenoma and idiopathic hyperaldosteronism cases referring to the sAVS. There was no significant difference between the concordance rate of the two sampling sites based on the sAVS diagnosis. CONCLUSIONS LCV sampling meets the SI criteria for successful AVS more frequently compared with CMT sampling, but neither was better than the other in terms of diagnosis under conditions of meeting the criteria. ADVANCES IN KNOWLEDGE LCV sampling would decrease the number of cases judged as AVS failure.
Collapse
Affiliation(s)
| | - Kohzoh Makita
- Department of Radiology, Nerima Hikarigaoka Hospital, Tokyo, Japan
| | - Kazuki Nakai
- Endocrinology and Diabetes Center, Yokohama Rosai Hospital, Yokohama, Japan
| | - Yuko Sato
- Department of Radiology, Nerima Hikarigaoka Hospital, Tokyo, Japan
| | - Yuya Tsurutani
- Endocrinology and Diabetes Center, Yokohama Rosai Hospital, Yokohama, Japan
| | - Jun Saito
- Endocrinology and Diabetes Center, Yokohama Rosai Hospital, Yokohama, Japan
| | - Seishi Matsui
- Department of Radiology, Yokohama Rosai Hospital, Yokohama, Japan
| | - Tetsuo Nishikawa
- Endocrinology and Diabetes Center, Yokohama Rosai Hospital, Yokohama, Japan
| |
Collapse
|
2
|
He X, Sueyoshi E, Tasaki Y, Miyazaki S, Murakami T, Nagayama H, Uetani M. Benefits of adrenal venous sampling with preoperative four-dimensional CT imaging. Acta Radiol 2023; 64:1280-1289. [PMID: 35945822 DOI: 10.1177/02841851221118799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The effects of adrenal venous sampling (AVS) may be limited by the anatomical variants of adrenal veins. PURPOSE To investigate the benefits of AVS for patients who underwent four-dimensional computed tomography (4D CT) before AVS. MATERIAL AND METHODS We reviewed the images of contrast-enhanced four phase three-dimensional (3D) and 4D CT in patients who received AVS between February 2010 and February 2021. A total of 112 patients (59 women; mean age = 55.3 ± 11.8 years) were enrolled. Of the entire population, 49.1% (55/112) underwent 4D CT, whereas 50.9% (57/112) underwent 3D CT. The anatomical features of adrenal veins and procedural data were obtained. Simple linear regression analyses were performed to determine the relationship between imaging protocols and AVS. RESULTS On comparison of the two groups, the 4D cohort had a higher success rate (98.2% vs. 78.9%; P = 0.001), shorter procedure and fluoroscopy time (73.6 ± 37.3 min vs. 110.5 ± 47.9 min; P < 0.001 and 28.7 ± 31.2 min vs. 97.4 ± 251.7 min; P = 0.047, respectively), lower radiation exposure (243.5 ± 315.5 mGycm2 vs. 613.4 ± 674.6 mGycm2; P < 0.001) and less contrast volume (46.2 ± 42.7 ml vs. 68.3 ± 47.4 ml vs; P = 0.014). In simple linear regression analysis, positive and negative identification of right adrenal vein before AVS significantly influenced the success rate (unstandardized coefficients [UC] = 0.304, standardized coefficients [SC] = 0.304; P = 0.001) and operation duration (UC = -46.124, SC = -0.318; P = 0.001). CONCLUSION Pre-procedural 4D CT may facilitate successful AVS. Compared with four-phase 3D CT, this protocol is better to shorten the operation and fluoroscopy time, and to reduce the radiation dose and contrast consumption.
Collapse
Affiliation(s)
- Xi He
- Department of Radiological Sciences, Graduate School of Biomedical Sciences, 12961Nagasaki University, Nagasaki, Japan
| | - Eijun Sueyoshi
- Department of Radiological Sciences, Graduate School of Biomedical Sciences, 12961Nagasaki University, Nagasaki, Japan
| | - Yutaro Tasaki
- Department of Radiological Sciences, Graduate School of Biomedical Sciences, 12961Nagasaki University, Nagasaki, Japan
| | - Shuhei Miyazaki
- Department of Radiological Sciences, Graduate School of Biomedical Sciences, 12961Nagasaki University, Nagasaki, Japan
| | - Tomonori Murakami
- Department of Radiological Sciences, Graduate School of Biomedical Sciences, 12961Nagasaki University, Nagasaki, Japan
| | - Hiroki Nagayama
- Department of Radiological Sciences, Graduate School of Biomedical Sciences, 12961Nagasaki University, Nagasaki, Japan
| | - Masataka Uetani
- Department of Radiological Sciences, Graduate School of Biomedical Sciences, 12961Nagasaki University, Nagasaki, Japan
| |
Collapse
|
3
|
Kim GJ, Kim MS, Hong HP, Lee YR, Choi YG. Adrenal Vein Sampling in Primary Aldosteronism: A Pictorial Essay for Optimal Left-Side Sampling. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2022; 84:386-397. [PMID: 37051402 PMCID: PMC10083640 DOI: 10.3348/jksr.2021.0188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 06/12/2022] [Accepted: 08/07/2022] [Indexed: 11/18/2022]
Abstract
Primary aldosteronism (PA) is a curable cause of hypertension. Recent studies have revealed that the actual prevalence of PA is higher than previously recognized. Adrenal vein sampling (AVS) is an essential diagnostic procedure for revealing the cause of PA and determining the treatment plan. The success of AVS is confirmed by comparing cortisol levels between the samples from each adrenal vein and peripheral vein. The failure rate of the procedure is reported to be high in the right adrenal vein, which is directly connected to the inferior vena cava, while that in the left adrenal vein is relatively low; however, this has rarely been reported. In this review, we introduce and analyze cases of failure in left adrenal vein sampling.
Collapse
Affiliation(s)
- Gi Joo Kim
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Myung Sub Kim
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyun Pyo Hong
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young Rae Lee
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yeon Gyu Choi
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| |
Collapse
|
4
|
Sato Y, Shirota G, Makita K, Itoh D, Hayashi TY, Akamatsu N, Matsui S, Saito J, Omura M, Nishikawa T, Abe O. Anatomical Variations of the Left Adrenal Vein Encountered During Venous Sampling. J Vasc Interv Radiol 2021; 33:71-77.e3. [PMID: 34555539 DOI: 10.1016/j.jvir.2021.09.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 08/25/2021] [Accepted: 09/09/2021] [Indexed: 11/18/2022] Open
Abstract
PURPOSE To identify anatomical variations in the left adrenal vein (LAV) and to evaluate the role of preprocedural contrast-enhanced computed tomography (CT) planning. METHODS The length of the left adrenal central vein (LACV), the vessel that receives blood from all tributaries of the left adrenal gland, was measured using venograms of patients who had undergone adrenal venous sampling (AVS) for the diagnosis of primary aldosteronism between October 2017 and December 2019. The anatomical variants of the LAV were described and classified. Contrast-enhanced CT was used to evaluate the detection rate of the following: (a) confluence of the left inferior phrenic vein and the LAV and (b) the last tributary flowing into the LAV. RESULTS In total, 311 patients (143 men, 168 women; mean age: 49.3 years ± 11.0) were enrolled. Of them, 9 (2.9%) patients had anatomical variants lacking a LACV. In patients with a LACV (n = 302), the venographic LACV length was 9.0 mm ± 3.9 (<1 mm in 9 patients). The detection rate of the confluence of the left inferior phrenic vein and LAV, as determined using contrast-enhanced CT, was high (96.2%), whereas that of the last tributary flowing into the LAV was low (0.8%). In 4 of 18 patients with short or absent LACV, the variant was visualized using contrast-enhanced CT. CONCLUSIONS In some patients, the LACV is absent or short, which is an anatomical variation. Understanding venographic anatomical variations can help avoid misleading results resulting from a suboptimal sampling site in AVS. For some subtypes, contrast-enhanced CT may also help in planning the AVS procedure.
Collapse
Affiliation(s)
- Yuko Sato
- Department of Radiology, Nerima Hikarigaoka Hospital, Tokyo, Japan; Department of Radiology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; Endocrinology and Diabetes Center, Yokohama Rosai Hospital, Yokohama City, Kanagawa, Japan
| | - Go Shirota
- Department of Radiology, Nerima Hikarigaoka Hospital, Tokyo, Japan.
| | - Kohzoh Makita
- Department of Radiology, Nerima Hikarigaoka Hospital, Tokyo, Japan; Endocrinology and Diabetes Center, Yokohama Rosai Hospital, Yokohama City, Kanagawa, Japan
| | - Daisuke Itoh
- Department of Radiology, Nerima Hikarigaoka Hospital, Tokyo, Japan
| | | | - Nobuhiko Akamatsu
- Department of Radiology, Nerima Hikarigaoka Hospital, Tokyo, Japan; Department of Radiology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Seishi Matsui
- Department of Interventional Radiology, Yokohama Rosai Hospital, Yokohama City, Kanagawa, Japan
| | - Jun Saito
- Endocrinology and Diabetes Center, Yokohama Rosai Hospital, Yokohama City, Kanagawa, Japan
| | - Masao Omura
- Endocrinology and Diabetes Center, Yokohama Rosai Hospital, Yokohama City, Kanagawa, Japan
| | - Tetsuo Nishikawa
- Endocrinology and Diabetes Center, Yokohama Rosai Hospital, Yokohama City, Kanagawa, Japan
| | - Osamu Abe
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| |
Collapse
|
5
|
Tannai H, Koike Y, Matsui S, Saito J, Makita K. A Rare Independent Left Inferior Phrenic Vein Sampling in a Left Adrenal Aldosterone-Producing Adenoma. Radiol Case Rep 2021; 16:1443-1446. [PMID: 33912260 PMCID: PMC8065199 DOI: 10.1016/j.radcr.2021.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 03/09/2021] [Indexed: 01/03/2023] Open
Abstract
This report presents a case of left adrenal aldosterone-producing adenoma (APA) diagnosed by segmental adrenal venous sampling in a patient with primary aldosteronism and a rare venous anomaly in which the left inferior phrenic vein (LIPV) and adrenal central vein entered the left renal vein separately. The outflow of tumor blood into the LIPV and the specimen from the LIPV that showed much higher aldosterone level than that from the adrenal central vein and tributaries were useful for proving the aldosterone hypersecretion from the APA. Sampling from the LIPV could be of diagnostic value for left APA.
Collapse
Affiliation(s)
- Hiromitsu Tannai
- Department of Radiology, Yokohama Rosai Hospital, Yokohama, 222-0036, Japan,Corresponding author:
| | - Yuya Koike
- Department of Radiology, Yokohama Rosai Hospital, Yokohama, 222-0036, Japan
| | - Seishi Matsui
- Department of Radiology, Yokohama Rosai Hospital, Yokohama, 222-0036, Japan
| | - Jun Saito
- Endocrinology & Diabetes Center, Yokohama Rosai Hospital, Yokohama, 222-0036, Japan
| | - Kohzoh Makita
- Department of Radiology, Nerima Hikarigaoka hospital, Tokyo, 179-0072, Japan
| |
Collapse
|
6
|
Quencer KB. Adrenal vein sampling: technique and protocol, a systematic review. CVIR Endovasc 2021; 4:38. [PMID: 33939038 PMCID: PMC8093361 DOI: 10.1186/s42155-021-00220-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 03/10/2021] [Indexed: 12/31/2022] Open
Abstract
Primary aldosteronism is the leading cause of secondary hypertension worldwide. Its deleterious effects outstrip those due to blood pressure elevation alone. An essential part of the work-up of a patient with primary aldosteronism is determining if aldosterone production is unilateral or bilateral. With the former, surgery offers a potential cure and better overall outcomes. Adrenal vein sampling is considered the most reliable method to determine whether production is unilateral or bilateral. Sampling may be non-diagnostic when the vein cannot be properly cannulated. But with proper knowledge and experience as well as the utilization of certain techniques, procedure success can be high. Multiple protocols exist; their rationale and drawbacks are reviewed here. This article will give the reader an overview of techniques for improving procedural success as well as background, rationale and evidence to guide one in choosing the appropriate procedural and interpretation protocol.
Collapse
Affiliation(s)
- Keith B Quencer
- Department of Radiology, Division of Interventional Radiology, University of Utah, 50 North Medical Drive, Salt Lake City, UT, 84132, USA.
| |
Collapse
|
7
|
Noda Y, Goshima S, Nagata S, Kawada H, Tanahashi Y, Kato T, Suwa T, Kawai N, Yabe D, Matsuo M. Utility of microcatheter in adrenal venous sampling for primary aldosteronism. Br J Radiol 2020; 93:20190636. [PMID: 32101447 DOI: 10.1259/bjr.20190636] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To evaluate the utility of microcatheter in adrenal venous sampling (AVS) for assessing aldosterone hypersecretion and the laterality in patients with primary aldosteronism. METHODS This retrospective study was approved by the institutional review board of Gifu University Hospital, and written informed consent was waived. A total of 37 consecutive patients with primary aldosteronism underwent AVS by inserting a microcatheter into the right adrenal central vein (RCV), left adrenal central vein (LCV), and left adrenal common trunk (CT) followed by AVS with 5-French (5-Fr) catheter. The diagnosis of aldosterone hypersecretion was confirmed if the plasma aldosterone level after the administration of cosyntropin injection was ≥14,000 pg/ml. The laterality of aldosterone hypersecretion was determined based on the lateralized and contralateral ratios. Aldosterone hypersecretion and the laterality were diagnosed and compared based on the results obtained using 5-Fr catheter and microcatheter. RESULTS Plasma aldosterone levels were significantly higher in the RCV, LCV, and CT selected using microcatheter than in the right and left adrenal veins (LAVs) selected using 5-Fr catheter (p < 0.0001-0.029). More aldosterone hypersecretion from the left adrenal gland was observed in the LCV (n = 28) and CT (n = 25) selected using microcatheter compared to the LAV selected using 5-Fr catheter (n = 6) (p < 0.0001). Diagnostic changes in the laterality from unilateral to bilateral were noted in 3 (8%) patients using microcatheter. CONCLUSION Microcatheter can effectively assess aldosterone hypersecretion and the laterality, especially in the LAV. ADVANCES IN KNOWLEDGE Especially for the left adrenal venous sampling, the tip of microcatheter could certainly reach the left adrenal vein orifice compared with 5-Fr catheter, therefore correct diagnosis is made and this leads to appropriate treatment.
Collapse
Affiliation(s)
- Yoshifumi Noda
- Department of Radiology, Gifu University, 1-1 Yanagido, Gifu 501-1194, Japan
| | - Satoshi Goshima
- Department of Diagnostic Radiology & Nuclear Medicine, Hamamatsu University, Shizuoka, Japan
| | - Shoma Nagata
- Department of Radiology, Gifu University, 1-1 Yanagido, Gifu 501-1194, Japan
| | - Hiroshi Kawada
- Department of Radiology, Gifu University, 1-1 Yanagido, Gifu 501-1194, Japan
| | - Yukichi Tanahashi
- Department of Radiology, Gifu University, 1-1 Yanagido, Gifu 501-1194, Japan
| | - Takehiro Kato
- Department of Diabetes and Endocrinology, Graduate School of Medicine, Gifu University, Gifu, Japan
| | - Tetsuya Suwa
- Department of Diabetes and Endocrinology, Graduate School of Medicine, Gifu University, Gifu, Japan
| | - Nobuyuki Kawai
- Department of Radiology, Gifu University, 1-1 Yanagido, Gifu 501-1194, Japan
| | - Daisuke Yabe
- Department of Diabetes and Endocrinology, Graduate School of Medicine, Gifu University, Gifu, Japan
| | - Masayuki Matsuo
- Department of Radiology, Gifu University, 1-1 Yanagido, Gifu 501-1194, Japan
| |
Collapse
|
8
|
Zagzag J, Sandhu L, Huang S, Perrier ND. Left Posterior Retroperitoneoscopic Adrenalectomy and Adrenal Vein Sampling. VideoEndocrinology 2018. [DOI: 10.1089/ve.2018.0117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Jonathan Zagzag
- Department of Surgical Oncology, MD Anderson Cancer Center, Houston, Texas
| | - Lakhbir Sandhu
- Department of Surgical Oncology, MD Anderson Cancer Center, Houston, Texas
| | - Steven Huang
- Department of Interventional Radiology, MD Anderson Cancer Center, Houston, Texas
| | - Nancy D. Perrier
- Department of Surgical Oncology, Unit 1484, The University of Texas M.D Anderson Cancer Center, Houston, Texas
| |
Collapse
|
9
|
Chen LS, Singh RJ. Niche point-of-care endocrine testing - Reviews of intraoperative parathyroid hormone and cortisol monitoring. Crit Rev Clin Lab Sci 2018; 55:115-128. [PMID: 29357735 DOI: 10.1080/10408363.2018.1425975] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Point-of-care (POC) testing, which provides quick test results in near-patient settings with easy-to-use devices, has grown continually in recent decades. Among near-patient and on-site tests, rapid intraoperative and intra-procedural assays are used to quickly deliver critical information and thereby improve patient outcomes. Rapid intraoperative parathyroid hormone (ioPTH) monitoring measures postoperative reduction of parathyroid hormone (PTH) to predict surgical outcome in patients with primary hyperparathyroidism, and therefore contributes to the change of parathyroidectomy to a minimally invasive procedure. In this review, recent progress in applying ioPTH monitoring to patients with secondary and tertiary hyperparathyroidism and other testing areas is discussed. In-suite cortisol monitoring facilitates the use of adrenal vein sampling (AVS) for the differential diagnosis of primary aldosteronism and adrenocorticotropic hormone (ACTH)-independent Cushing syndrome. In clinical and psychological research settings, POC testing is also useful for rapidly assessing cortisol in plasma and saliva samples as a biomarker of stress. Careful resource utilization and coordination among stakeholders help to determine the best approach for implementing cost-effective POC testing. Technical advances in integrating appropriate biosensors with microfluidics-based devices hold promise for future real-time POC cortisol monitoring.
Collapse
Affiliation(s)
- Li-Sheng Chen
- a Bureau of Laboratories , Michigan Department of Health and Human Services , Lansing , MI , USA
| | - Ravinder J Singh
- b Laboratory Medicine and Pathology , Mayo Clinic , Rochester , MN , USA
| |
Collapse
|
10
|
Kishino M, Yoshimoto T, Nakadate M, Katada Y, Kanda E, Nakaminato S, Saida Y, Ogawa Y, Tateishi U. Optimization of left adrenal vein sampling in primary aldosteronism: Coping with asymmetrical cortisol secretion. Endocr J 2017; 64:347-355. [PMID: 28132968 DOI: 10.1507/endocrj.ej16-0433] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
We evaluated the influence of catheter sampling position and size on left adrenal venous sampling (AVS) in patients with primary aldosteronism (PA) and analyzed their relationship to cortisol secretion. This retrospective study included 111 patients with a diagnosis of primary aldosteronism who underwent tetracosactide-stimulated AVS. Left AVS was obtained from two catheter positions - the central adrenal vein (CAV) and the common trunk. For common trunk sampling, 5-French catheters were used in 51 patients, and microcatheters were used in 60 patients. Autonomous cortisol secretion was evaluated with a low-dose dexamethasone suppression test in 87 patients. The adrenal/inferior vena cava cortisol concentration ratio [selectivity index (SI)] was significantly lower in samples from the left common trunk than those of the left CAV and right adrenal veins, but this difference was reduced when a microcatheter was used for common trunk sampling. Sample dilution in the common trunk of the left adrenal vein can be decreased by limiting sampling speed with the use of a microcatheter. Meanwhile, there was no significant difference in SI between the left CAV and right adrenal veins. Laterality, determined according to aldosterone/cortisol ratio (A/C ratio) based criteria, showed good reproducibility regardless of sampling position, unlike the absolute aldosterone value based criteria. However, in 11 cases with autonomous cortisol co-secretion, the cortisol hypersecreting side tended to be underestimated when using A/C ratio based criteria. Left CAV sampling enables symmetrical sampling, and may be essential when using absolute aldosterone value based criteria in cases where symmetrical cortisol secretion is uncertain.
Collapse
Affiliation(s)
- Mitsuhiro Kishino
- Department of Diagnostic Radiology and Nuclear Medicine, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo 113-8519, Japan
| | | | | | | | | | | | | | | | | |
Collapse
|
11
|
Umakoshi H, Wada N, Ichijo T, Kamemura K, Matsuda Y, Fuji Y, Kai T, Fukuoka T, Sakamoto R, Ogo A, Suzuki T, Tsuiki M, Naruse M. Optimum position of left adrenal vein sampling for subtype diagnosis in primary aldosteronism. Clin Endocrinol (Oxf) 2015; 83:768-73. [PMID: 26123796 DOI: 10.1111/cen.12847] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Revised: 04/20/2015] [Accepted: 06/26/2015] [Indexed: 01/08/2023]
Abstract
CONTEXT Although adrenal vein sampling (AVS) is the standard method for subtype diagnosis in primary aldosteronism (PA), protocol details including the sampling position in the adrenal vein are not standardized. OBJECTIVE To establish the optimum sampling position in the left adrenal vein based on postoperative outcome in PA patients. DESIGN AND SETTING Retrospective study in nine referral centres. PARTICIPANTS Of 496 consecutive PA patients who underwent AVS between 2006 and 2013, 217 with successful AVS under cosyntropin stimulation, and with concomitant data from two positions: proximal (common trunk) and distal (central vein) to the junction with the inferior phrenic vein, were included. MAIN OUTCOME MEASURES Discordant rate of subtype diagnosis between common trunk and central vein, and postoperative outcomes in patients with discordant results. RESULTS Subtype diagnosis using common trunk and central vein was discordant in 10 (4·6%) of the 217 patients (κ = 0·87, P < 0·05). Of these 10 patients, eight with left unilateral subtype and two with bilateral subtype using common trunk data showed bilateral subtype and unilateral subtype, respectively, using central vein data. Five patients with left unilateral subtype and one with bilateral subtype by common trunk data underwent unilateral adrenalectomy. All six patients were cured of PA after adrenalectomy, resulting in false-negative rates of 17% (1/6) by common trunk data, and 83% (5/6) by central vein data. CONCLUSION In view of its better potential diagnostic accuracy, technical ease, lower cost and lower risk of vein rupture, blood sampling from the common trunk of the left adrenal vein may be preferable as the standard method of AVS in patients with PA, although additional studies in a larger number of cases are required.
Collapse
Affiliation(s)
- Hironobu Umakoshi
- Department of Endocrinology, Metabolism, and Hypertension, Clinical Research Institute, National Hospital Organisation Kyoto Medical Centre, Kyoto, Japan
| | - Norio Wada
- Department of Diabetes and Endocrinology, Sapporo City Hospital, Sapporo, Japan
| | - Takamasa Ichijo
- Department of Diabetes and Endocrinology, Saiseikai Yokohama City Toubu Hospital, Yokohama, Japan
| | - Kohei Kamemura
- Department of Cardiology, Akashi Medical Centre, Akashi, Japan
| | - Yuichi Matsuda
- Department of Cardiology, Sanda City Hospital, Sanda, Japan
| | - Yuichi Fuji
- Department of Cardiology, Hiroshima General Hospital of West Japan Railway Company, Hiroshima, Japan
| | - Tatsuya Kai
- Department of Cardiology, Saiseikai Tondabayashi Hospital, Tondabayashi, Japan
| | - Tomikazu Fukuoka
- Department of Internal Medicine, Matsuyama Red Cross Hospital, Matsuyama, Japan
| | - Ryuichi Sakamoto
- Department of Endocrinology and Metabolism, National Hospital Organisation, Kyushu Medical Centre, Fukuoka, Japan
| | - Atsushi Ogo
- Department of Endocrinology and Metabolism, National Hospital Organisation, Kyushu Medical Centre, Fukuoka, Japan
| | - Tomoko Suzuki
- Department of Public Health, Kitasato University School of Medicine, Tokyo, Japan
| | - Mika Tsuiki
- Department of Endocrinology, Metabolism, and Hypertension, Clinical Research Institute, National Hospital Organisation Kyoto Medical Centre, Kyoto, Japan
| | - Mitsuhide Naruse
- Department of Endocrinology, Metabolism, and Hypertension, Clinical Research Institute, National Hospital Organisation Kyoto Medical Centre, Kyoto, Japan
| |
Collapse
|
12
|
Satani N, Ota H, Seiji K, Morimoto R, Kudo M, Iwakura Y, Ono Y, Nezu M, Omata K, Ito S, Satoh F, Takase K. Intra-adrenal Aldosterone Secretion: Segmental Adrenal Venous Sampling for Localization. Radiology 2015; 278:265-74. [PMID: 26147784 DOI: 10.1148/radiol.2015142159] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
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 ± 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 ± 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.
Collapse
Affiliation(s)
- Nozomi Satani
- From the Department of Diagnostic Radiology (N.S., H.O., K.S., K.T.) and Division of Nephrology, Endocrinology, and Vascular Medicine, Department of Medicine (R.M., M.K., Y.I., Y.O., M.N., K.O., S.I., F.S.), Tohoku University Hospital, 1-1 Seiryo, Aoba, Sendai 980-8574, Japan
| | - Hideki Ota
- From the Department of Diagnostic Radiology (N.S., H.O., K.S., K.T.) and Division of Nephrology, Endocrinology, and Vascular Medicine, Department of Medicine (R.M., M.K., Y.I., Y.O., M.N., K.O., S.I., F.S.), Tohoku University Hospital, 1-1 Seiryo, Aoba, Sendai 980-8574, Japan
| | - Kazumasa Seiji
- From the Department of Diagnostic Radiology (N.S., H.O., K.S., K.T.) and Division of Nephrology, Endocrinology, and Vascular Medicine, Department of Medicine (R.M., M.K., Y.I., Y.O., M.N., K.O., S.I., F.S.), Tohoku University Hospital, 1-1 Seiryo, Aoba, Sendai 980-8574, Japan
| | - Ryo Morimoto
- From the Department of Diagnostic Radiology (N.S., H.O., K.S., K.T.) and Division of Nephrology, Endocrinology, and Vascular Medicine, Department of Medicine (R.M., M.K., Y.I., Y.O., M.N., K.O., S.I., F.S.), Tohoku University Hospital, 1-1 Seiryo, Aoba, Sendai 980-8574, Japan
| | - Masataka Kudo
- From the Department of Diagnostic Radiology (N.S., H.O., K.S., K.T.) and Division of Nephrology, Endocrinology, and Vascular Medicine, Department of Medicine (R.M., M.K., Y.I., Y.O., M.N., K.O., S.I., F.S.), Tohoku University Hospital, 1-1 Seiryo, Aoba, Sendai 980-8574, Japan
| | - Yoshitsugu Iwakura
- From the Department of Diagnostic Radiology (N.S., H.O., K.S., K.T.) and Division of Nephrology, Endocrinology, and Vascular Medicine, Department of Medicine (R.M., M.K., Y.I., Y.O., M.N., K.O., S.I., F.S.), Tohoku University Hospital, 1-1 Seiryo, Aoba, Sendai 980-8574, Japan
| | - Yoshikiyo Ono
- From the Department of Diagnostic Radiology (N.S., H.O., K.S., K.T.) and Division of Nephrology, Endocrinology, and Vascular Medicine, Department of Medicine (R.M., M.K., Y.I., Y.O., M.N., K.O., S.I., F.S.), Tohoku University Hospital, 1-1 Seiryo, Aoba, Sendai 980-8574, Japan
| | - Masahiro Nezu
- From the Department of Diagnostic Radiology (N.S., H.O., K.S., K.T.) and Division of Nephrology, Endocrinology, and Vascular Medicine, Department of Medicine (R.M., M.K., Y.I., Y.O., M.N., K.O., S.I., F.S.), Tohoku University Hospital, 1-1 Seiryo, Aoba, Sendai 980-8574, Japan
| | - Kei Omata
- From the Department of Diagnostic Radiology (N.S., H.O., K.S., K.T.) and Division of Nephrology, Endocrinology, and Vascular Medicine, Department of Medicine (R.M., M.K., Y.I., Y.O., M.N., K.O., S.I., F.S.), Tohoku University Hospital, 1-1 Seiryo, Aoba, Sendai 980-8574, Japan
| | - Sadayoshi Ito
- From the Department of Diagnostic Radiology (N.S., H.O., K.S., K.T.) and Division of Nephrology, Endocrinology, and Vascular Medicine, Department of Medicine (R.M., M.K., Y.I., Y.O., M.N., K.O., S.I., F.S.), Tohoku University Hospital, 1-1 Seiryo, Aoba, Sendai 980-8574, Japan
| | - Fumitoshi Satoh
- From the Department of Diagnostic Radiology (N.S., H.O., K.S., K.T.) and Division of Nephrology, Endocrinology, and Vascular Medicine, Department of Medicine (R.M., M.K., Y.I., Y.O., M.N., K.O., S.I., F.S.), Tohoku University Hospital, 1-1 Seiryo, Aoba, Sendai 980-8574, Japan
| | - Kei Takase
- From the Department of Diagnostic Radiology (N.S., H.O., K.S., K.T.) and Division of Nephrology, Endocrinology, and Vascular Medicine, Department of Medicine (R.M., M.K., Y.I., Y.O., M.N., K.O., S.I., F.S.), Tohoku University Hospital, 1-1 Seiryo, Aoba, Sendai 980-8574, Japan
| |
Collapse
|
13
|
Trerotola SO, Asmar M, Yan Y, Fraker DL, Cohen DL. Failure Mode Analysis in Adrenal Vein Sampling: A Single-Center Experience. J Vasc Interv Radiol 2014; 25:1611-9. [DOI: 10.1016/j.jvir.2014.06.029] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Revised: 06/23/2014] [Accepted: 06/29/2014] [Indexed: 10/24/2022] Open
|