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Optimization of left adrenal vein sampling in primary aldosteronism: Coping with asymmetrical cortisol secretion
- Source :
- Endocrine journal. 64(3)
- Publication Year :
- 2017
-
Abstract
- We evaluated the influence of catheter sampling position and size on left adrenal venous sampling (AVS) in patients with primary aldosteronism (PA) and analyzed their relationship to cortisol secretion. This retrospective study included 111 patients with a diagnosis of primary aldosteronism who underwent tetracosactide-stimulated AVS. Left AVS was obtained from two catheter positions - the central adrenal vein (CAV) and the common trunk. For common trunk sampling, 5-French catheters were used in 51 patients, and microcatheters were used in 60 patients. Autonomous cortisol secretion was evaluated with a low-dose dexamethasone suppression test in 87 patients. The adrenal/inferior vena cava cortisol concentration ratio [selectivity index (SI)] was significantly lower in samples from the left common trunk than those of the left CAV and right adrenal veins, but this difference was reduced when a microcatheter was used for common trunk sampling. Sample dilution in the common trunk of the left adrenal vein can be decreased by limiting sampling speed with the use of a microcatheter. Meanwhile, there was no significant difference in SI between the left CAV and right adrenal veins. Laterality, determined according to aldosterone/cortisol ratio (A/C ratio) based criteria, showed good reproducibility regardless of sampling position, unlike the absolute aldosterone value based criteria. However, in 11 cases with autonomous cortisol co-secretion, the cortisol hypersecreting side tended to be underestimated when using A/C ratio based criteria. Left CAV sampling enables symmetrical sampling, and may be essential when using absolute aldosterone value based criteria in cases where symmetrical cortisol secretion is uncertain.
- Subjects :
- Cortisol secretion
Male
medicine.medical_specialty
Hydrocortisone
Endocrinology, Diabetes and Metabolism
030209 endocrinology & metabolism
Vena Cava, Inferior
030204 cardiovascular system & hematology
Inferior vena cava
Severity of Illness Index
Dexamethasone
Catheterization
Veins
Diagnosis, Differential
03 medical and health sciences
chemistry.chemical_compound
0302 clinical medicine
Endocrinology
Primary aldosteronism
Phlebotomy
Internal medicine
Adrenal Glands
Hyperaldosteronism
medicine
Humans
Aldosterone
Cushing Syndrome
Left adrenal vein
Retrospective Studies
business.industry
Reproducibility of Results
Middle Aged
medicine.disease
Adrenal Cortex Neoplasms
Catheter
medicine.vein
chemistry
Dexamethasone suppression test
Laterality
Adrenocortical Adenoma
Asymptomatic Diseases
cardiovascular system
Cardiology
Cosyntropin
Female
business
Subjects
Details
- ISSN :
- 13484540
- Volume :
- 64
- Issue :
- 3
- Database :
- OpenAIRE
- Journal :
- Endocrine journal
- Accession number :
- edsair.doi.dedup.....4ce06fb587e5cb7f1e4e45e2c43849cb