Adrenal Venous Sampling for Subtype Diagnosis of Primary Hyperaldosteronism
Adrenal venous sampling (AVS) is the key procedure for lateralization of primary hyperaldosteronism (PA) before surgery. Identification of the adrenal veins using computed tomography (CT) and intraoperative cortisol assay facilitates the success of catheterization. Although administration of adrenoc...
| Main Authors: | , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Korean Endocrine Society
2021-10-01
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| Series: | Endocrinology and Metabolism |
| Subjects: | |
| Online Access: | http://www.e-enm.org/upload/pdf/enm-2021-1192.pdf |
| _version_ | 1818343241512124416 |
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| author | Mitsuhide Naruse Akiyo Tanabe Koichi Yamamoto Hiromi Rakugi Mitsuhiro Kometani Takashi Yoneda Hiroki Kobayashi Masanori Abe Youichi Ohno Nobuya Inagaki Shoichiro Izawa Masakatsu Sone |
| author_facet | Mitsuhide Naruse Akiyo Tanabe Koichi Yamamoto Hiromi Rakugi Mitsuhiro Kometani Takashi Yoneda Hiroki Kobayashi Masanori Abe Youichi Ohno Nobuya Inagaki Shoichiro Izawa Masakatsu Sone |
| author_sort | Mitsuhide Naruse |
| collection | DOAJ |
| description | Adrenal venous sampling (AVS) is the key procedure for lateralization of primary hyperaldosteronism (PA) before surgery. Identification of the adrenal veins using computed tomography (CT) and intraoperative cortisol assay facilitates the success of catheterization. Although administration of adrenocorticotropic hormone (ACTH) has benefits such as improving the success rate, some unilateral cases could be falsely diagnosed as bilateral. Selectivity index of 5 with ACTH stimulation to assess the selectivity of catheterization and lateralization index (LI) >4 with ACTH stimulation for unilateral diagnosis is used in many centers. Co-secretion of cortisol from the tumor potentially affects the lateralization by the LI. Patients aged <35 years with hypokalemia, marked aldosterone excess, and unilateral adrenal nodule on CT have a higher probability of unilateral disease. Patients with normokalemia, mild aldosterone excess, and no adrenal tumor on CT have a higher probability of bilateral disease. Although no methods have 100% specificity for subtype diagnosis that would allow bypassing AVS, prediction of the subtype should be considered when recommending AVS to patients. Methodological standardization and strict indication improve diagnostic quality of AVS. Development of non-invasive imaging and biochemical markers will drive a paradigm shift in the clinical practice of PA. |
| first_indexed | 2024-12-13T16:27:27Z |
| format | Article |
| id | doaj.art-bce7f047585e4f91a821d18b22885574 |
| institution | Directory Open Access Journal |
| issn | 2093-596X 2093-5978 |
| language | English |
| last_indexed | 2024-12-13T16:27:27Z |
| publishDate | 2021-10-01 |
| publisher | Korean Endocrine Society |
| record_format | Article |
| series | Endocrinology and Metabolism |
| spelling | doaj.art-bce7f047585e4f91a821d18b228855742022-12-21T23:38:35ZengKorean Endocrine SocietyEndocrinology and Metabolism2093-596X2093-59782021-10-0136596597310.3803/EnM.2021.11922228Adrenal Venous Sampling for Subtype Diagnosis of Primary HyperaldosteronismMitsuhide Naruse0Akiyo Tanabe1Koichi Yamamoto2Hiromi Rakugi3Mitsuhiro Kometani4Takashi Yoneda5Hiroki Kobayashi6Masanori Abe7Youichi Ohno8Nobuya Inagaki9Shoichiro Izawa10Masakatsu Sone11 Endocrine Center and Clinical Research Center, Ijinkai Takeda General Hospital, Kyoto, Japan Department of Diabetes, Endocrinology and Metabolism, National Center for Global Health and Medicine, Tokyo, Japan Department of Geriatric and General Medicine, Osaka University Graduate School of Medicine, Osaka, Japan Department of Geriatric and General Medicine, Osaka University Graduate School of Medicine, Osaka, Japan Department of Health Promotion and Medicine of the Future, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan Department of Health Promotion and Medicine of the Future, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan Division of Nephrology, Hypertension and Endocrinology, Nihon University School of Medicine, Tokyo, Japan Division of Nephrology, Hypertension and Endocrinology, Nihon University School of Medicine, Tokyo, Japan Department of Diabetes, Endocrinology and Nutrition, Kyoto University Graduate School of Medicine, Kyoto, Japan Department of Diabetes, Endocrinology and Nutrition, Kyoto University Graduate School of Medicine, Kyoto, Japan Division of Endocrinology and Metabolism, Tottori University Faculty of Medicine, Yonago, Japan Division of Metabolism and Endocrinology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, JapanAdrenal venous sampling (AVS) is the key procedure for lateralization of primary hyperaldosteronism (PA) before surgery. Identification of the adrenal veins using computed tomography (CT) and intraoperative cortisol assay facilitates the success of catheterization. Although administration of adrenocorticotropic hormone (ACTH) has benefits such as improving the success rate, some unilateral cases could be falsely diagnosed as bilateral. Selectivity index of 5 with ACTH stimulation to assess the selectivity of catheterization and lateralization index (LI) >4 with ACTH stimulation for unilateral diagnosis is used in many centers. Co-secretion of cortisol from the tumor potentially affects the lateralization by the LI. Patients aged <35 years with hypokalemia, marked aldosterone excess, and unilateral adrenal nodule on CT have a higher probability of unilateral disease. Patients with normokalemia, mild aldosterone excess, and no adrenal tumor on CT have a higher probability of bilateral disease. Although no methods have 100% specificity for subtype diagnosis that would allow bypassing AVS, prediction of the subtype should be considered when recommending AVS to patients. Methodological standardization and strict indication improve diagnostic quality of AVS. Development of non-invasive imaging and biochemical markers will drive a paradigm shift in the clinical practice of PA.http://www.e-enm.org/upload/pdf/enm-2021-1192.pdfaldosteroneadrenocorticotropic hormoneadenomacatherterizationhyperaldosteronism |
| spellingShingle | Mitsuhide Naruse Akiyo Tanabe Koichi Yamamoto Hiromi Rakugi Mitsuhiro Kometani Takashi Yoneda Hiroki Kobayashi Masanori Abe Youichi Ohno Nobuya Inagaki Shoichiro Izawa Masakatsu Sone Adrenal Venous Sampling for Subtype Diagnosis of Primary Hyperaldosteronism Endocrinology and Metabolism aldosterone adrenocorticotropic hormone adenoma catherterization hyperaldosteronism |
| title | Adrenal Venous Sampling for Subtype Diagnosis of Primary Hyperaldosteronism |
| title_full | Adrenal Venous Sampling for Subtype Diagnosis of Primary Hyperaldosteronism |
| title_fullStr | Adrenal Venous Sampling for Subtype Diagnosis of Primary Hyperaldosteronism |
| title_full_unstemmed | Adrenal Venous Sampling for Subtype Diagnosis of Primary Hyperaldosteronism |
| title_short | Adrenal Venous Sampling for Subtype Diagnosis of Primary Hyperaldosteronism |
| title_sort | adrenal venous sampling for subtype diagnosis of primary hyperaldosteronism |
| topic | aldosterone adrenocorticotropic hormone adenoma catherterization hyperaldosteronism |
| url | http://www.e-enm.org/upload/pdf/enm-2021-1192.pdf |
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