What is the role of adrenal venous sampling in the workup of primary aldosteronism?

Updated: Mar 24, 2020
  • Author: Gabriel I Uwaifo, MD; Chief Editor: Romesh Khardori, MD, PhD, FACP  more...
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Answer

Adrenal venous sampling probably has its greatest utility when adrenal imaging findings are completely normal despite biochemical evidence for primary aldosteronism and in settings in which bilateral adrenal pathology is present on imaging and the biochemistry suggests the presence of a functional aldosteronoma.

The test also has utility in resolving the exact etiology in cases of primary aldosteronism in which discordance exists between the biochemical findings and the radiologic findings with regard to whether the primary aldosteronism is due to idiopathic adrenal hyperplasia (IAH) or an aldosteronoma.

One series reported that 41% of patients with a normal adrenal CT scan who had biochemical evidence of primary aldosteronism actually had lateralizable disease, while 49% of patients with bilateral micronodules on CT scan also had lateralizable disease. [38] Even in cases in which only a single adrenal nodule was found on imaging, when adrenal venous sampling was performed, it confirmed lateralizable disease in just 51-66% of cases.

A retrospective study by Kline et al indicated that using the strictest adrenal venous sampling criteria in the lateralization of primary aldosteronism may cause a large number of patients to be incorrectly diagnosed as having a bilateral, rather than unilateral, condition and, consequently, to be excluded from surgical intervention. Looking at 80 primary aldosterone cases that were addressed with surgery, the investigators found that the use of lateralization indexes of 3:1 to 5:1 would have resulted in a missed surgical opportunity in 10-23%. [39]


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