[Show abstract][Hide abstract] ABSTRACT: 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) > or = 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) > or = 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) > or = 1.1) a ratio of (A/C)(side)/(A/C)(control) > or = 2 provided the best compromise of sensitivity and false positive rate for lateralization of the etiology of PA.
[Show abstract][Hide abstract] ABSTRACT: Objectives: To prospectively investigate whether AVS is useful to identify the aetiology of excess aldosterone secretion in pts with the biochemical features of PA and equivocal CT and MRI findings.Design and Methods: Between 1992 and 1999, 104 referred hypertensive pts (46 f and 58 m; age: 49.3 ± 12 yrs) to our department were diagnosed as PA, based on supine (sAldo) and captopril-suppressed plasma aldosterone (cAldo), supine plasma renin activity (sPRA), serum K+, and a logistic multivariate discriminant analysis score. AVS for measurement of plasma aldosterone (Aldo) and cortisol (C) levels was performed in all since CT scan (n = 104) and MRI (n = 69) did not provide unequivocal identification of an aldosterone-producing adenoma (APA). It was judged to be selective and thus used for diagnostic purposes when the ratio between C levels in each adrenal vein and inferior vena cava plasma was >1.2.Results: Forty pts (38%) were found to have APA; the average tumor size, as assessed by CT, MRI and pathology, resulted to be 1.25 ± 0.52 cm. AVS resulted to be bilaterally selective in 78.1% of all cases, being selective on the right and left side in 94% and 86%, respectively. AVS provided a definite aetiologic diagnosis of PA in 88% of cases where it was selective. Adrenal vein rupture leading to loss of unilateral adrenal function, as assessed by scintigraphy, occurred in one pt (1%) with idiopathic hyperaldosteronism.Conclusions: AVS was feasible and safe in the vast majority of PA pts with equivocal or negative CT and MRI scan. When selective, it provided an accurate lateralization of the aetiology of PA.
American Journal of Hypertension - AMER J HYPERTENS. 01/2000; 13(4).