Current Hypertension Reports

, Volume 9, Issue 2, pp 90–97 | Cite as

New concepts in adrenal vein sampling for aldosterone in the diagnosis of primary aldosteronism

  • Gian Paolo Rossi


Improved diagnostic techniques and adoption of a systematic and thorough diagnostic workup can lead to identification of the surgically correctable forms of primary aldosteronism (PA) far more frequently than expected. Adrenalectomy can provide long-term normalization of blood pressure and correction of PA in most patients with an aldosterone-producing adenoma. Forms needing surgical correction are generally held to be less common than forms requiring medical therapy; however, this can be a misconception arising from the lack of systematic use of adrenal vein sampling (AVS). Currently AVS still remains the “gold standard” for identifying unilateral causes of PA that are surgically curable. The criteria for selecting patients to undergo AVS, the technique for performing AVS, and the criteria for analyzing and interpreting its results are summarized here.


Inferior Vena Cava Primary Aldosteronism Adrenal Mass Aldosterone Secretion Adrenal Venous Sampling 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References and Recommended Reading

  1. 1.
    Rossi GP, Bernini G, Caliumi C, et al.: for the PAPY Study Investigators: A prospective study of the prevalence of primary aldosteronism in 1125 hypertensive patients. J Am Coll Cardiol 2006, 48:2293–2300.PubMedCrossRefGoogle Scholar
  2. 2.
    Rayner BL, Opie LH, Davidson JS: The aldosterone/renin ratio as a screening test for primary aldosteronism. S Afr Med J 2000, 90:394–400.PubMedGoogle Scholar
  3. 3.
    Rossi E, Regolisti G, Negro A, et al.: High prevalence of primary aldosteronism using postcaptopril plasma aldosterone to renin ratio as a screening test among Italian hypertensives. Am J Hypertens 2002, 15:896–902.PubMedCrossRefGoogle Scholar
  4. 4.
    Schwartz GL, Chapman AB, Boerwinkle E, et al.: Screening for primary aldosteronism: implications of an increased plasma aldosterone/renin ratio. Clin Chem 2002, 48:1919–1923.PubMedGoogle Scholar
  5. 5.
    Rossi GP, Rossi E, Pavan E, et al.: Screening for primary aldosteronism with a logistic multivariate discriminant analysis. Clin Endocrinol (Oxf) 1998, 49:713–723.CrossRefGoogle Scholar
  6. 6.
    Rossi GP: Surgically correctable hypertension caused by primary aldosteronism. Best Pract Res Clin Endocr Metab 2006, 20:385–400.CrossRefGoogle Scholar
  7. 7.
    Mannhart M, Ludin H, Veyrat R, Ziegler WH: Secondary hyperaldosteronism caused by cervical phaeochromocytoma cured by ablation of the tumor. Helv Med Acta 1971, 35:479–483.PubMedGoogle Scholar
  8. 8.
    Kitajima W, Saruta T, Kondo K, et al.: A case of secondary aldosteronism induced by pheochromocytoma. J Urol 1975, 114:141–143.PubMedGoogle Scholar
  9. 9.
    Wajiki M, Ogawa A, Fukui J, et al.: Coexistence of aldosteronoma and pheochromocytoma in an adrenal gland. J Surg Oncol 1985, 28:75–78.PubMedCrossRefGoogle Scholar
  10. 10.
    Gordon RD, Bachmann AW, Klemm SA, et al.: An association of primary aldosteronism and adrenaline-secreting phaeochromocytoma. Clin Exp Pharmacol Physiol 1994, 21:219–222.PubMedGoogle Scholar
  11. 11.
    Tan GH, Carney JA, Grant CS, Young WF, Jr.: Coexistence of bilateral adrenal phaeochromocytoma and idiopathic hyperaldosteronism. Clin Endocrinol (Oxf) 1996, 44:603–609.CrossRefGoogle Scholar
  12. 12.
    Stowasser M, Klemm SA, Tunny TJ, et al.: Response to unilateral adrenalectomy for aldosterone-producing adenoma: effect of potassium levels and angiotensin responsiveness. Clin Exp Pharmacol Physiol 1994, 21:319–322.PubMedGoogle Scholar
  13. 13.
    Omura M, Sasano H, Fujiwara T, et al.: Unique cases of unilateral hyperaldosteronemia due to multiple adrenocortical micronodules, which can only be detected by selective adrenal venous sampling. Metabolism 2002, 51:350–355.PubMedCrossRefGoogle Scholar
  14. 14.
    Morioka M, Kobayashi T, Sone A, et al.: Primary aldosteronism due to unilateral adrenal hyperplasia: report of two cases and review of the literature. Endocr J 2000, 47:443–449.PubMedGoogle Scholar
  15. 15.
    Katayama Y, Takata N, Tamura T, et al.: A case of primary aldosteronism due to unilateral adrenal hyperplasia. Hypertens Res 2005, 28:379–384.PubMedCrossRefGoogle Scholar
  16. 16.
    Rossi GP, Zanin L, De Toni R, et al.: Dopaminergic regulation of aldosterone secretion in primary aldosteronism: a clinical study. Hypertens Res 1994, 17:105–115.Google Scholar
  17. 17.
    Mulatero P, Dluhy RG, Giacchetti G, et al.: Diagnosis of primary aldosteronism: from screening to subtype differentiation. Trends Endocrinol Metab 2005, 16:114–119.PubMedCrossRefGoogle Scholar
  18. 18.
    Rossi GP, Ganzaroli C, Miotto D, et al.: Dynamic testing with high-dose adrenocorticotrophic hormone does not improve lateralization of aldosterone oversecretion in primary aldosteronism patients. J Hypertens 2006, 24:371–379.PubMedGoogle Scholar
  19. 19.
    Fallo F, Barzon L, Boscaro M, Sonino N: Coexistence of aldosteronoma and contralateral nonfunctioning adrenal adenoma in primary aldosteronism. Am J Hypertens 1997, 10:476–478.PubMedCrossRefGoogle Scholar
  20. 20.
    Magill SB, Raff H, Shaker JL, et al.: Comparison of adrenal vein sampling and computed tomography in the differentiation of primary aldosteronism. J Clin Endocrinol Metab 2001, 86:1066–1071.PubMedCrossRefGoogle Scholar
  21. 21.
    Kloos RT, Gross MD, Francis IR, et al.: Incidentally discovered adrenal masses. Endocr Rev 1995, 16:460–484.PubMedCrossRefGoogle Scholar
  22. 22.
    Mantero F, Terzolo M, Arnaldi G, et al.: A survey on adrenal incidentaloma in Italy. Study Group on Adrenal Tumors of the Italian Society of Endocrinology. J Clin Endocrinol Metab 2000, 85:637–644.PubMedCrossRefGoogle Scholar
  23. 23.
    Blumenfeld JD, Sealey JE, Schlussel Y, et al.: Diagnosis and treatment of primary hyperaldosteronism. Ann Intern Med 1994, 121:877–885.PubMedGoogle Scholar
  24. 24.
    Stowasser M, Gordon RD, Rutherford JC, et al.: Diagnosis and management of primary aldosteronism. J Renin Angiotensin Aldosterone Syst 2001, 2:156–169.PubMedGoogle Scholar
  25. 25.
    Young WF, Jr: Primary aldosteronism: management issues. Ann N Y Acad Sci 2002, 970:61–76.PubMedGoogle Scholar
  26. 26.
    Rossi GP, Chiesura-Corona M, Tregnaghi A, et al.: Imaging of aldosterone-secreting adenomas: a prospective comparison of computed tomography and magnetic resonance imaging in 27 patients with suspected primary aldosteronism. J Hum Hypertens 1993, 7:357–363.PubMedGoogle Scholar
  27. 27.
    Lockhart ME, Smith JK, Kenney PJ: Imaging of adrenal masses. Eur J Radiol 2002, 41:95–112.PubMedCrossRefGoogle Scholar
  28. 28.
    Gordon RD: Primary aldosteronism. J Endocrinol Invest 1995, 18:495–511.PubMedGoogle Scholar
  29. 29.
    Young WF Jr, Stanson AW, Grant CS, et al.: Primary aldosteronism: adrenal venous sampling. Surgery 1996, 120:913–919.PubMedCrossRefGoogle Scholar
  30. 30.
    Phillips JL, Walther MM, Pezzullo JC, et al.: Predictive value of preoperative tests in discriminating bilateral adrenal hyperplasia from an aldosterone-producing adrenal adenoma. J Clin Endocrinol Metab 2000, 85:4526–4533.PubMedCrossRefGoogle Scholar
  31. 31.
    Rossi GP, Sacchetto A, Chiesura-Corona M, et al.: 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. J Clin Endocrinol Metab 2001, 86:1083–1090.PubMedCrossRefGoogle Scholar
  32. 32.
    Young WF, Stanson AW, Thompson GB, et al.: Role for adrenal venous sampling in primary aldosteronism. Surgery 2004, 136:1227–1235.PubMedCrossRefGoogle Scholar
  33. 33.
    Daunt N: Adrenal vein sampling: how to make it quick, easy, and successful. Radiographics 2005, 25 (Suppl 1):S143–S158.PubMedCrossRefGoogle Scholar
  34. 34.
    Enberg U, Volpe C, Hoog A, et al.: Postoperative differentiation between unilateral adrenal adenoma and bilateral adrenal hyperplasia in primary aldosteronism by mRNA expression of the gene CYP11B2. Eur J Endocrinol 2004, 151:73–85.PubMedCrossRefGoogle Scholar
  35. 35.
    Espiner EA, Ross DG, Yandle TG, et al.: Predicting surgically remedial primary aldosteronism: role of adrenal scanning, posture testing, and adrenal vein sampling. J Clin Endocrinol Metab 2003, 88:3637–3644.PubMedCrossRefGoogle Scholar
  36. 36.
    Rossi GP, Pitter G, Miotto D: To stimulate or not to stimulate: is adrenocorticotrophic hormone testing necessary, or not? J Hypertens 2007, 25:481–484.CrossRefGoogle Scholar
  37. 37.
    Hogan MJ, McRae J, Schambelan M, Biglieri EG: Location of aldosterone-producing adenomas with 131 I-19-iodocho-lesterol. N Engl J Med 1976, 294:410–414.PubMedCrossRefGoogle Scholar
  38. 38.
    Nomura K, Kusakabe K, Maki M, et al.: Iodomethylnorcholesterol uptake in an aldosteronoma shown by dexamethasone-suppresion scintigraphy: relationship to adenoma size and functional activity. J Clin Endocrinol Metab 1990, 71:825–830.PubMedCrossRefGoogle Scholar
  39. 39.
    Gross MD, Shapiro B, Freitas JE: Limited significance of asymmetric adrenal visualization on dexamethasone-suppression scintigraphy. J Nucl Med 1985, 26:43–48.PubMedGoogle Scholar
  40. 40.
    Vetter H, Fischer M, Galanski M, et al.: Primary aldosteronism: diagnosis and noninvasive lateralization procedures. Cardiology 1985, 72(Suppl 1):57–63.PubMedCrossRefGoogle Scholar
  41. 41.
    Gordon RD: Primary aldosteronism. J Endocrinol Invest 1995, 18:495–511.PubMedGoogle Scholar
  42. 42.
    Mansoor GA, Malchoff CD, Arici MH, et al.: Unilateral adrenal hyperplasia causing primary aldosteronism: limitations of I-131 norcholesterol scanning. Am J Hypertens 2002, 15:459–464.PubMedCrossRefGoogle Scholar
  43. 43.
    Bossuyt PM, Reitsma JB, Bruns DE, et al.: The STARD statement for reporting studies of diagnostic accuracy: explanation and elaboration. Clin Chem 2003, 49:7–18.PubMedCrossRefGoogle Scholar
  44. 44.
    Diaz-Cano SJ, de Miguel M, Blanes A, et al.: Clonality as expression of distinctive cell kinetics patterns in nodular hyperplasias and adenomas of the adrenal cortex. Am J Pathol 2000, 156:311–319.PubMedGoogle Scholar
  45. 45.
    Rossi GP, Vendraminelli R, Cesari M, Pessina AC: A thoracic mass with hypertension and hypokalaemia. Lancet 2000, 356:1570.PubMedCrossRefGoogle Scholar
  46. 46.
    Seccia TM, Fassina A, Nussdorfer GG, et al.: Aldosterone-producing adrenocortical carcinoma: an unusual cause of Conn’s syndrome with an ominous clinical course. Endocr Relat Cancer 2005, 12:149–159.PubMedCrossRefGoogle Scholar
  47. 47.
    Wolf-Maier K, Cooper RS, Banegas JR, et al.: Hypertension prevalence and blood pressure levels in 6 European countries, Canada, and the United States. JAMA 2003, 289:2363–2369.PubMedCrossRefGoogle Scholar
  48. 48.
    Rundback JH, Sacks D, Kent KC, et al.: Guidelines for the reporting of renal artery revascularization in clinical trials. American Heart Association. Circulation 2002, 106:1572–1585.PubMedCrossRefGoogle Scholar
  49. 49.
    Dluhy RG, Lifton RP: Glucocorticoid-remediable aldosteronism. J Clin Endocrinol Metab 1999, 84:4341–4344.PubMedCrossRefGoogle Scholar
  50. 50.
    Mulatero P, Veglio F, Pilon C, et al.: Diagnosis of glucocorticoid-remediable aldosteronism in primary aldosteronism: aldosterone response to dexamethasone and long polymerase chain reaction for chimeric gene. J Clin Endocrinol Metab 1998, 83:2573–2575.PubMedCrossRefGoogle Scholar
  51. 51.
    Pascoe L, Jeunemaitre X, Lebrethon MC, et al.: Glucocorticoid-suppressible hyperaldosteronism and adrenal tumors occurring in a single French pedigree. J Clin Invest 1995, 96:2236–2246.PubMedCrossRefGoogle Scholar
  52. 52.
    Milliez P, Girerd X, Plouin PF, et al.: Evidence for an increased rate of cardiovascular events in patients with primary aldosteronism. J Am Coll Cardiol 2005, 45:1243–1248.PubMedCrossRefGoogle Scholar

Copyright information

© Current Medicine Group LLC 2007

Authors and Affiliations

  1. 1.Department of Clinical and Experimental Medicine, Internal Medicine 4University HospitalPadovaItaly

Personalised recommendations