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Selective Use of Adrenal Venous Sampling in the Lateralization of Aldosterone-producing Adenomas

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Abstract

Introduction

It has been suggested that routine adrenal venous sampling (AVS) is necessary to lateralize an aldosterone-producing adenoma in patients with primary hyperaldosteronism. However, the success rate of AVS is variable, with potential risks. We review our experience at University of California San Francisco (UCSF), where AVS is used only selectively, to determine outcomes with this approach.

Methods

All patients undergoing adrenalectomy for aldosteronoma at UCSF from January 1995 to October 2004 were included. Outcome after adrenalectomy was determined based on plasma levels of aldosterone and potassium, rates of persistent hypertension, and reduced use of antihypertensive medications.

Results

Altogether, 65 patients were included in the study, 52 (80%) of whom had their adrenal tumors lateralized based on computed tomography scans, magnetic resonance imaging, or both. The remaining 13 (20%) patients had doubtful localization of their lesions on imaging. We did not routinely perform AVS in patients with definitive imaging findings. Thus, only 4 (8%) patients with definitive imaging findings underwent AVS, and one was unsuccessful. Of the 13 patients with doubtful lateralization on imaging, 8 underwent AVS. With this practice, biochemical cure rates after adrenalectomy were up to 100%, and hypertension resolved or was improved in 85% of patients.

Conclusions

AVS may be performed selectively only when preoperative imaging cannot definitively lateralize the aldosteronoma. This practice in our center has resulted in high cure rates. During the era of improved imaging resolution and experience, mandatory routine AVS is not necessary to achieve high cure rates for aldosteronomas.

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References

  1. Fehaily MA, Duh QY. Clinical manifestation of aldosteronoma. Surg Clin North Am 2004;84:887–905

    Article  PubMed  Google Scholar 

  2. Montori VM, Young WF Jr. Use of plasma aldosterone concentration-to-plasma renin activity ratio as a screening test for primary aldosteronism: a systemic review of the literature. Endocrinol Metab Clin North Am 2002;31:619–632

    Article  CAS  PubMed  Google Scholar 

  3. Young WF Jr. Minireview: primary aldosteronism—changing concepts in diagnosis and treatment. Endocrinology 2003;144:2208–2213

    Article  CAS  PubMed  Google Scholar 

  4. Young WF, Stanson AW, Thompson GB, et al. Role for adrenal venous sampling in primary aldosteronism. Surgery 2004;136:1227–1235

    Article  PubMed  Google Scholar 

  5. McAlister FA, Lewanczuk RZ. Primary hyperaldosteronism and adrenal incidentaloma: an argument for physiologic testing before adrenalectomy. Can J Surg 1998;41:299–305

    CAS  PubMed  Google Scholar 

  6. 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

    Article  CAS  PubMed  Google Scholar 

  7. Graham DJ, McHenry CR. The adrenal incidentaloma: guidelines for evaluation and recommendations for management. Surg Oncol Clin N Am 1998;7:749–764

    CAS  PubMed  Google Scholar 

  8. Hollak CE, Prummel MF, Tiel-van Buul MM. Bilateral adrenal tumors in primary aldosteronism: localization of a unilateral aldosteronoma by dexamethasone suppression scan. J Intern Med 1991;229:545–548

    Article  CAS  PubMed  Google Scholar 

  9. Fallo F, Barzon L, Boscaro M, et al. Coexistence of aldosteronoma and contralateral nonfunctioning adrenal adenoma in primary aldosteronism. Am J Hypertens 1997;10:476–478

    Article  CAS  PubMed  Google Scholar 

  10. Pekarske SL, Herold DA. Primary aldosteronism in a patient with an aldosterone-producing adenoma. Clin Chem 1993;39:1729–1733

    CAS  PubMed  Google Scholar 

  11. Iwaoka T, Umeda T, Naomi S, et al. Lateralisation of aldosterone-producing adenoma in primary aldosteronism. Nippon Naibunpi Gakkai Zasshi 1988;64:1273–1280

    CAS  PubMed  Google Scholar 

  12. Takaha M, Tada Y, Nakano E, et al. Surgical management of primary aldosteronism: progress in localization studies and operative treatment. Hinyokika Kiyo 1987;33:491–500

    CAS  PubMed  Google Scholar 

  13. Opocher G, Rocco S, Carpene G, et al. Primary hyperaldosteronism. Minerva Endocrinol 1995;20:49–54

    CAS  PubMed  Google Scholar 

  14. Pagny JY, Chatellier G, Raynaud A, et al. Localization of primary hyperaldosteronism. Ann Endocrinol (Paris) 1988;49:340–343

    CAS  Google Scholar 

  15. Ou YC, Yang CR, Chang CL, et al. Comparison of five modalities in localization of primary aldosteronism. Zhonghua Yi Xue Za Zhi 1994;53:7–12

    CAS  PubMed  Google Scholar 

  16. Young WF Jr, Stanson AW, Grant CS, et al. Primary aldosteronism: adrenal venous sampling. Surgery 1996;120:913–920

    PubMed  Google Scholar 

  17. Mcareavey D, Brown JJ, Cumming AM, et al. Pre-operative localization of aldosterone-secreting adrenal adenomas. Clin Endocrinol (Oxf) 1981;15:593–606

    CAS  Google Scholar 

  18. Nascimbeni L, Lyonnet D, Vincent M, et al. Adrenal vein catheterization in primary hyperaldosteronism: aid in surgical decision making? Arch Mal Coeur Vaiss 2001;94:874–878

    CAS  PubMed  Google Scholar 

  19. Mayo-Smith WW, Boland GW, Noto RB, et al. State-of-the-art adrenal imaging. Radiographics 2001;21:995–1012

    CAS  PubMed  Google Scholar 

  20. Korobkin M, Brodeur FJ, Yutzy GG, et al. Differentiation of adrenal adenomas from nonadenomas using CT attenuation values. AJR Am J Roentgenol 1996;166:531–536

    CAS  PubMed  Google Scholar 

  21. Lingam RK, Sohaib SA, Vlahos I, et al. CT of primary hyperaldosteronism (Conn’s syndrome): the value of measuring the adrenal gland. AJR Am J Roentgenol 2003;181:843–849

    CAS  PubMed  Google Scholar 

  22. 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

    Article  CAS  PubMed  Google Scholar 

  23. Kloos RT, Gross MD, Francis IR, et al. Incidentally discovered adrenal masses. Endocr Rev 1995;16:460–484

    Article  CAS  PubMed  Google Scholar 

  24. 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

    Article  CAS  PubMed  Google Scholar 

  25. Celen O, O’Brien MJ, Melby JC, et al. Factors influencing outcome of surgery for primary aldosteronism. Arch Surg 1996;131:646–650

    CAS  PubMed  Google Scholar 

  26. Lo CY, Tam PC, Kung AW, et al. Primary aldosteronism: results of surgical treatment. Ann Surg 1996;224:125–130

    Article  CAS  PubMed  Google Scholar 

  27. Sawka AM, Young WF, Thompson GB, et al. Primary aldosteronism: factors associated with normalization of blood pressure after surgery. Ann Intern Med 2001;135:258–261

    CAS  PubMed  Google Scholar 

  28. Simon D, Goretzki PE, Lollert A, et al. Persistent hypertension after successful adrenal operation. Surgery 1993;114:1189–1195

    CAS  PubMed  Google Scholar 

  29. Brunt LM, Moley JF, Doherty GM, et al. Outcomes analysis in patients undergoing laparoscopic adrenalectomy for hormonally active adrenal tumors. Surgery 2001;130:629–634

    Article  CAS  PubMed  Google Scholar 

  30. Rossi H, Kim A, Prinz RA. Primary hyperaldosteronism in the era of laparoscopic adrenalectomy. Am Surg 2002;68:253–256

    PubMed  Google Scholar 

  31. Sapienza P, Cavallaro A. Persistent hypertension after removal of adrenal tumors. Eur J Surg 1999;165:187–192

    Article  CAS  PubMed  Google Scholar 

  32. Proye CA, Mulliez EA, Carnaille BM, et al. Essential hypertension: first reason for persistent hypertension after unilateral adrenalectomy for primary aldosteronism? Surgery 1998;124:1128–1133

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Surgery, University of California San Francisco, 4150 Clement Street, San Francisco, California, 94121, USA

    Yah Yuen Tan MB, Jennifer B. Ogilvie MD, Frederick Triponez MD, Nadine R. Caron MD, Electron K. Kebebew MD, Orlo H. Clark MD & Quan-Yang Duh MD

  2. Surgical Service, VA Medical Center, 4150 Clement Street, San Francisco, CA, 94121, USA

    Quan-Yang Duh MD

Authors
  1. Yah Yuen Tan MB
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  2. Jennifer B. Ogilvie MD
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  3. Frederick Triponez MD
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  4. Nadine R. Caron MD
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  5. Electron K. Kebebew MD
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  6. Orlo H. Clark MD
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  7. Quan-Yang Duh MD
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Corresponding author

Correspondence to Quan-Yang Duh MD.

Additional information

This work was presented at the meeting of the International Association of Endocrine Surgeons in Durban, South Africa, August 22, 2005

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Tan, Y.Y., Ogilvie, J.B., Triponez, F. et al. Selective Use of Adrenal Venous Sampling in the Lateralization of Aldosterone-producing Adenomas. World J. Surg. 30, 879–885 (2006). https://doi.org/10.1007/s00268-005-0622-8

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  • DOI: https://doi.org/10.1007/s00268-005-0622-8

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