・To understand the indications of AVS. ・To understand the anatomy of the intra-adrenal vein, appropriate sampling sites according to patient’s anatomical vascular variations. ・To understand how to evaluate the laboratory data obtained from tributary sampling for diagnosis of primary aldosteronism.

Primary Aldosteronism (PA) is one of the most common cause of secondary hypertension, with an estimated prevalence of 3-11% in hypertensive patients [1, 2]. Two main causes of PA are aldosterone-producing adenoma (APA) and idiopathic hyperaldosteronism (IHA). It is essential to distinguish unilateral subtype from bilateral subtype PA, as well as make an accurate diagnosis of PA, because unilateral subtype PA is treated by adrenalectomy, whereas bilateral subtype is treated by antihypertensive drugs. Accurate diagnosis and treatment options are important, because PA patients have a...

Indications of AVS Both the US Endocrine Society and the Japan Endocrine Society guidelines recommend that AVS be performed in all patients who have the diagnosis of PA and want to pursue surgical management [4, 5]. The diagnosis of PA is made by endocrinological work up as follows ( Table 1 ): Screening test: Hypertension with PAC/PRA>200. PAC: Plasma aldosterone concentration (pg/ml) PRA: Plasma renin activity (ng/ml/hr) Definite diagnosis of PA Captopril-challenging test: PAC/PRA>200 Upright furosemide-loading test: PRA<2 Saline-loading test: PAC>60 Dynamic enhancement CT prior...

AVS is essential to determine the diagnosis of PA Pre-procedual CT is useful to evaluate the anatomy of adrenal veins, especially for the right side S-AVS is more useful than C-AVS in diagnosis of laterality on PA patients. S-AVS of right side is more difficult than that of the left side. Technical advancement is required for sampling from bilateral adrenal vein tributaries. Criterion of the positive laterality is still controversial for tributary veins. Complications are rare, but careful catheterizaion and injection of contrast medium to...

M. Kobayashi. Department of Radiology. Toho University Omori Medical Center. K. Matsumoto. Department of Radiology. Toho University Omori Medical Center. K. Suzuki. Department of Radiology. Toho University Omori Medical Center. K. Tamura. Department of Radiology. Toho University Omori Medical Center. H. Suzuki. Department of Radiology. Toho University Omori Medical Center. N. Shiraga. Department of Radiology. Toho University Omori Medical Center.

Multatero P, Stowasser M, Loh K-C et al. (2004) Increased diagnosis of primary aldosteronism, including surgically correctable forms, in centers from five continents. J Clin Endocrinol Metab 89:1045-1050. Rossi GP, Bernini G, Caliumi C et al. (2006) A retrospective study of the prevalence of primary aldosteronism in 1,125 hypertensive patients. J Am Coll Cardiol 48:2293-2300. Multatero P, Monticone S, Bertello C et al. (2013) Long-term cardio-and cerebrovascular events in patients with primary aldosteronism. J Clin Endocrinol Metab 98:4826-4833. Funder JW, Carey RM, Fardella C et...