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Updated: Apr 25, 2026
A Novel Method: Super-selective Adrenal Venous Sampling
Published on: September 15, 2017
Aldosterone suppression on contralateral adrenal during adrenal vein sampling does not predict blood pressure
Silvia Monticone1, Fumitoshi Satoh, Andrea Viola
1Division of Internal Medicine and Hypertension (S.M., A.V., J.B., F.V., P.M.), Department of Medical Sciences, and Division of Endocrinology, Diabetology, and Metabolism (B.L., M.M.), Department of Medical Sciences, and Department of Radiology (D.R.), University of Torino, 10126 Torino, Italy; Division of Nephrology, Endocrinology, and Vascular Medicine (F.S., R.M., M.K., Y.I., S.I.), Tohoku University Hospital, Sendai 980-8579, Japan; Medizinische Klinik und Poliklinik IV (E.F., A.R., M.R.), Campus Innenstadt, and Institut für Klinische Radiologie (C.D.), Ludwig Maximilians University Hospital, 81377 Munich, Germany; Departments of Nephrology (O.V., X.G.) and Endocrinology and Diabetology (H.S.D.), Medical Faculty, University of Düsseldorf, 40225 Düsseldorf, Germany; Department of Clinical and Experimental Medicine (G.B., D.C.), University of Pisa, 56126 Pisa, Italy; Department of Clinical Endocrinology (M.Q.), Charité Campus Mitte, Charité University Medicine Berlin and Endocrinology in Charlottenburg, 10627 Berlin, Germany; Division of Endocrinology (V.R., E.P., G.G.), Ospedali Riuniti Umberto I-GM Lancisi G Salesi, Università Politecnica delle Marche, 60126 Ancona, Italy; Clinical Chemistry Laboratory (G.M.), Azienda Ospedaliera Città della Salute e della Scienza di Torino, 10126 Torino, Italy.
Context:
Adrenal vein sampling (AVS) is the only reliable means to distinguish between aldosterone-producing adenoma and bilateral adrenal hyperplasia, the two most common subtypes of primary aldosteronism (PA). AVS protocols are not standardized and vary widely between centers.
Objective:
The objective of the study was to retrospectively investigate whether the presence of contralateral adrenal (CL) suppression of aldosterone secretion was associated with improved postoperative outcomes in patients who underwent unilateral adrenalectomy for PA.
Setting:
The study was carried out in eight different referral centers in Italy, Germany, and Japan.
Patients:
From 585 consecutive AVS in patients with confirmed PA, 234 procedures met the inclusion criteria and were used for the subsequent analyses.
Results:
Overall, 82% of patients displayed contralateral suppression. This percentage was significantly higher in ACTH stimulated compared with basal procedures (90% vs 77%). The CL ratio was inversely correlated with the aldosterone level at diagnosis and, among AVS parameters, with the lateralization index (P = .02 and P = .01, respectively). The absence of contralateral suppression was not associated with a lower rate of response to adrenalectomy in terms of both clinical and biochemical parameters, and patients with CL suppression underwent a significantly larger reduction in the aldosterone levels after adrenalectomy.
Conclusions:
For patients with lateralizing indices of greater than 4 (which comprised the great majority of subjects in this study), CL suppression should not be required to refer patients to adrenalectomy because it is not associated with a larger blood pressure reduction after surgery and might exclude patients from curative surgery.
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