Utility of microcatheter in adrenal venous sampling for primary aldosteronism

To evaluate the utility of microcatheter in adrenal venous sampling (AVS) for assessing aldosterone hypersecretion and the laterality in patients with primary aldosteronism.

This retrospective study was approved by the institutional review board of Gifu University Hospital, and written informed consent was waived. A total of 37 consecutive patients with primary aldosteronism underwent AVS by inserting a microcatheter into the right adrenal central vein (RCV), left adrenal central vein (LCV), and left adrenal common trunk (CT) followed by AVS with 5-French (5-Fr) catheter. The diagnosis of aldosterone hypersecretion was confirmed if the plasma aldosterone level after the administration of cosyntropin injection was ≥14,000 pg/ml. The laterality of aldosterone hypersecretion was determined based on the lateralized and contralateral ratios. Aldosterone hypersecretion and the laterality were diagnosed and compared based on the results obtained using 5-Fr catheter and microcatheter.

Plasma aldosterone levels were significantly higher in the RCV, LCV, and CT selected using microcatheter than in the right and left adrenal veins (LAVs) selected using 5-Fr catheter (p < 0.0001-0.029). More aldosterone hypersecretion from the left adrenal gland was observed in the LCV (n = 28) and CT (n = 25) selected using microcatheter compared to the LAV selected using 5-Fr catheter (n = 6) (p < 0.0001). Diagnostic changes in the laterality from unilateral to bilateral were noted in 3 (8%) patients using microcatheter.

Microcatheter can effectively assess aldosterone hypersecretion and the laterality, especially in the LAV.

Especially for the left adrenal venous sampling, the tip of microcatheter could certainly reach the left adrenal vein orifice compared with 5-Fr catheter, therefore correct diagnosis is made and this leads to appropriate treatment.