Aims and objectives
Aldosterone has two basic functions: regulation of extracellular volume and regulation of potassium metabolism.
Primary hyperaldosteronism is the most common cause of secondary hypertension with a prevalence of approximately 5-20%.
Patients with primary hyperaldosteronism often take several drugs to control blood pressure.
They have hypokalemia and as a consequence polyuria,
polydipsia,
paresthesias,
weakness,
fatigue,
headaches etc.
In most cases (> 95%),
primary hyperaldosteronism is caused by an aldosterone-producing adenoma or bilateral adrenal hyperplasia.
(Figure 1)
The diagnosis of primary hyperaldosteronism is clinical and biochemical.
Once...
Methods and materials
We obtained informed consent in all patients.
Adrenal vein sampling was performed in 37 patients with primary aldosteronism (32 men,
5 women; mean age: 60,4 years; minimum age: 40 years; maximum age: 74 years.
(Figure 3)
The diagnosis of primary hyperaldosteronism was clinical and biochemical.
CT,
MRI and adrenal venous sampling were used to identify its etiology (CT and MRI protocols are shown in Figure 4).
CT and MRI were used to rule out malignant causes (Figure 5) and to obtain anatomical information of the...
Results
Between January 2009 and August 2018,
adrenal vein sampling was performed in 37 patients (88% men,
12% women; mean age: 60,4 years; minimum age: 40 years; maximum age: 74 years.
(Figure 3).
The adrenal vein sampling success rate was 97% (36 of 37) with the only failed intervention was due to cannulation failure of the right adrenal vein.
Figure11,
12,
13,
14,
16,
17 and 18showsthe main difficulties in the adrenal vein sampling.
No patient had a contraindication to the procedure (Iodinated contrast allergy,
decubitus...
Conclusion
Adrenal vein sampling is essential when considering surgery even if the patient has a CT/MRI with a unilateral macronodule.
MRI / CT showed useful for excluding the aldosterone-producing carcinoma and to provide anatomical information,
such as the location of the adrenal veins for subsequent catheterization,
but insufficient for correct lateralization.
Adrenal vein sampling remains a "gold standard" procedure in differentiation between unilateral and bilateral disease.
The adrenal vein sampling procedure,
preceded by adrenal CT or adrenal MRI,
may be implemented into daily diagnostic practice safely...
Personal information
Reda Britel,
MD
Hospital Universitari Son Espases,Universitat de les Illes Balears
Carretera de Valldemossa,
79,
07120
Palma de Mallorca
Illes Balears,
07120
Spain
Phone: +34871205000
e-mail:
[email protected]
References
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Intra-adrenal Aldosterone Secretion: Segmental Adrenal Venous Sampling for Localization .Radiology 2016,
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