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A Novel Method: Super-selective Adrenal Venous Sampling
Published on: September 15, 2017
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Aldosterone Synthase Expression vs. Cross-Sectional Imaging in Lateralized Primary Aldosteronism.
Livia M Mermejo1,2, Yueting Liu1, Elaine Caoili3
1Division of Metabolism, Endocrinology, and Diabetes, University of Michigan, Ann Arbor, MI.
Summary
Cross-sectional imaging often mismatches CYP11B2 immunohistochemistry in primary aldosteronism (PA), limiting its use for guiding surgery. Aldosterone source mapping via imaging should be approached with caution due to frequent discrepancies.
Area of Science:
- Endocrinology
- Surgical Oncology
- Pathology
Background:
- Adrenal vein sampling (AVS) is standard for primary aldosteronism (PA) surgical guidance.
- Limited AVS availability leads many centers to use cross-sectional imaging.
- This study evaluates imaging accuracy against detailed adrenal tissue analysis.
Purpose of the Study:
- To assess the concordance between cross-sectional imaging and CYP11B2 immunohistochemistry (IHC) for identifying aldosterone-producing lesions in PA.
- To determine the reliability of imaging for guiding unilateral adrenalectomy in PA patients.
Main Methods:
- Retrospective cohort study of 173 PA patients undergoing unilateral adrenalectomy (2012-2024).
- Blinded cross-sectional imaging interpretation compared with CYP11B2 IHC on adrenal tissue.
- Analysis of discrepancies and correlation with patient demographics and mutations.
Main Results:
- CYP11B2 IHC identified aldosterone sources in 97% of patients, with single adenomas/nodules in 72.3%.
- Imaging concordance with IHC for a single aldosterone source was found in only 31% of patients.
- Significant discrepancies (47.4%) occurred, including additional nodules, hyperplasia, or unmapped positive foci.
Conclusions:
- CYP11B2 IHC and imaging findings corresponded in about half of lateralized PA cases.
- These results question the reliability of cross-sectional imaging for targeted therapy in PA.
- Caution is advised against solely relying on imaging for surgical guidance in PA.
