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Cardiovasc Intervent Radiol (2010) 33:760765
DOI 10.1007/s00270-009-9722-4
CLINICAL INVESTIGATION
Adrenal Venous Sampling: Where Is the Aldosterone Disappearing to?
Miroslav Solar Jiri Ceral Antonin Krajina
Marek Ballon Eva Malirova Milos Brodak
Jan Cap
Received: 28 July 2009 / Accepted: 14 September 2009 / Published online: 1 October 2009 The Author(s) 2009. This article is published with open access at Springerlink.com
Abstract Adrenal venous sampling (AVS) is generally considered to be the gold standard in distinguishing uni-lateral and bilateral aldosterone hypersecretion in primary hyperaldosteronism. However, during AVS, we noticed a considerable variability in aldosterone concentrations among samples thought to have come from the right adrenal glands. Some aldosterone concentrations in these samples were even lower than in samples from the inferior vena cava. We hypothesized that the samples with low aldosterone levels were unintentionally taken not from the right adrenal gland, but from hepatic veins. Therefore, we sought to analyze the impact of unintentional cannulation of hepatic veins on AVS. Thirty consecutive patients referred for AVS were enrolled. Hepatic vein sampling was implemented in our standardized AVS protocol. The data were collected and analyzed prospectively. AVS was successful in 27 patients (90%), and hepatic vein cannulation
was successful in all procedures performed. Cortisol concentrations were not signicantly different between the hepatic vein and inferior vena cava samples, but aldosterone concentrations from hepatic venous blood (median, 17 pmol/l; range, 40860 pmol/l) were markedly lower than in samples from the inferior vena cava (median, 860 pmol/l; range, 4604510 pmol/l). The observed difference was statistically signicant (P \ 0.001). Aldosterone concentrations in the hepatic veins are signicantly lower than in venous blood taken from the inferior vena cava. This nding is important for AVS because hepatic veins can easily be mistaken for adrenal veins as a result of their close anatomic proximity.
Keywords Adrenal venous sampling
Primary aldosteronism
Introduction
In primary aldosteronism (PA), the choice of treatment depends on the lateralization of aldosterone secretion. In cases with unilateral aldosterone overproduction, adrenal-ectomy leads to improvement or even a complete cure of high blood pressure. Therefore, it is important to differentiate between bilateral and unilateral forms of PA [1, 2].
The only diagnostic method that can recognize unilateral aldosterone hypersecretion is adrenal venous sampling (AVS) [3, 4]. The adequacy of adrenal blood...