Usefulness of adrenal vein sampling in the evaluation of aldosteronism

To determine the usefulness of adrenal vein sampling (AVS) in patients referred for surgical management of primary aldosteronism (PA).

From July 2001 to September 2006, 12 patients with a mean age of 49.3 years (range 31-65 yrs) presented for evaluation. All patients had PA based on serologic screening tests and were evaluated with CT abdominal imaging. Eleven (92%) patients underwent AVS with corticotropin stimulation. Ten patients underwent laparoscopic adrenalectomy for resection of an aldosterone-producing adenoma.

All patients had an adrenal adenoma seen on CT, mean size 14.8 mm (range 6-27 mm). AVS was performed in the 11 patients. When compared with CT findings, eight (73%) patients demonstrated aldosterone hypersecretion from the adrenal with the adenoma. Two (18%) patients demonstrated hypersecretion from the contralateral, normal-appearing gland. One (9%) patient demonstrated bilateral aldosterone hypersecretion, consistent with bilateral adrenal hyperplasia. After surgical removal of the gland that demonstrated hypersecretion on AVS, all patients experienced resolution of hypokalemia, five (50%) patients had resolution of hypertension, and five (50%) patients had significant reductions in the number of hypertensive medications.

AVS is a superior test when compared with CT imaging in subtype identification of PA and for determination of occult hypersecretion from the adrenal. Patients who are evaluated for potential adrenalectomy should routinely undergo AVS.