Intra-adrenal Aldosterone Secretion: Segmental Adrenal Venous Sampling for Localization

Area of Science:

• Endocrinology
• Interventional Radiology
• Nephrology

Background:

• Primary aldosteronism is a leading cause of secondary hypertension.
• Accurate localization of aldosterone hypersecretion is crucial for guiding treatment decisions.
• Traditional adrenal venous sampling (AVS) may not fully capture intra-adrenal hormone distribution.

Purpose of the Study:

• To evaluate the utility of segmental adrenal venous sampling (S-AVS) for detecting and localizing intra-adrenal aldosterone secretion.
• To assess the capability of S-AVS in identifying heterogeneous hormone distribution within the adrenal gland.

Main Methods:

• S-AVS was performed in 65 patients with primary aldosteronism.
• Microcatheters were used to sample effluent from first-degree tributary veins.
• Lateralization and segmental aldosterone/cortisol ratios were analyzed after cosyntropin stimulation.

Main Results:

• The S-AVS success rate was high at 98% (64/65 patients).
• Diagnoses included unilateral hypersecretion (30 patients), bilateral without suppressed segments (22), and bilateral with suppressed segments (12).
• No severe complications were reported.

Conclusions:

• S-AVS effectively identifies heterogeneous intra-adrenal aldosterone secretion.
• Identification of suppressed segments allows for consideration of adrenal-sparing surgery in bilateral aldosterone-producing adenomas.