Adrenal Venous Sampling in Young Patients with Primary Aldosteronism. Extravagance or Irreplaceable?

Area of Science:

• Endocrinology
• Nephrology
• Surgical Oncology

Background:

• Current guidelines suggest adrenal venous sampling (AVS) may not be mandatory for young primary aldosteronism (PA) patients with solitary adrenal adenomas.
• The sufficiency of conventional imaging alone to differentiate unilateral from bilateral PA in younger patients remains unclear.

Purpose of the Study:

• To determine if imaging alone is adequate for distinguishing unilateral from bilateral PA in patients aged 40 years or younger.
• To evaluate the diagnostic accuracy of imaging compared to AVS in this demographic.

Main Methods:

• Retrospective analysis of 45 PA patients (aged 26-40) who underwent AVS.
• Comparison of imaging-based laterality with AVS results.
• Assessment of surgical outcomes using Primary Aldosteronism Surgical Outcomes criteria.

Main Results:

• Imaging inaccurately suggested bilateral PA in 4 of 25 patients with unilateral disease confirmed by AVS; all achieved success after unilateral adrenalectomy.
• Five patients with bilateral PA (confirmed by AVS) had solitary nodules on imaging; 2 treated unilaterally had poor outcomes.
• Two patients under 35 showed discordant AVS and imaging results.

Conclusions:

• Imaging alone inaccurately predicts laterality in a significant number of young PA patients.
• AVS is recommended for subtype evaluation in young adults with PA, even those 35 years or younger, contrary to current guidelines.