Learning objectives
Why adrenal venous sampling is indispensable in the management of primary aldosteronism patients
How to visualize and evaluate adrenal veins by MDCT
Technical tips,
pitfalls,
and anatomical variation of the adrenal veins nesessaryto achieve high success rate of adrenal venous sampling
Typical imagesof adrenal venous sampling
Background
Prevalence rate of primary aldosteronism
Primary aldosteronism is increasingly recognized as a cause of secondary hypertension with prevalence rate of approximately 10% in hypertensive populations.
Why adrenal venous sampling is indispensable in the management of primary aldosteronism patients
Management of primary aldosteronism
It is critically important to distinguish unilateral aldosterone producing adenoma from bilateral idiopathic adrenal hyperplasia because unilateral hypersecretion of aldosterone can be treated surgically.
CT is not reliable in subtype diagnosis of primary aldosteronism
Morphological diagnosis by MDCT is not reliable in diagnosing...
Imaging findings OR Procedure details
Capability of MDCT to detect adrenal vein:
MDCT precisely detects the right adrenal venous location and course with information of accessory hepatic veins.
MDCT protocol:
Anatomical types of the right adrenal vein and newly developed catheters for right adrenal venous sampling
We classified right adrenal venous anatomy into 5 types (upward type,
downward type,
medial insertion type,
medial direction type,
and common trunk with accessory hepatic vein),developing 5 types of catheters (Adselect series,
Hanako Medical,
Tokyo,
Japan) suitable for each anatomy.
Adrenal venous sampling using...
Conclusion
Primary aldosteronism is increasingly recognized as a cause of secondary hypertension. Its prevalence in hypertensive populations is estimated at approximately 10%.
Unilateral aldosterone hypersecretion caused by unilateral aldosterone producing adenoma is a curable form of hypertension.
Although selective adrenal venous sampling is a difficult procedure,
high success rate of adrenal venous sampling can be achieved by MDCT anatomical information,
whichleads to adequate management of hypertension patients.
Personal Information
Kei Takase,
MD,
PhD,
Department of Diagnostic Radiology,
Tohoku University School of Medicine
1-1,
Seiryo,
Aoba-ku,
Sendai,
Miyagi,
Japan 980-8574
e-mail:
[email protected]
References
Mulatero P,
Stowasser M,
and Loh KC.
Increased diagnosis of primary aldosteronism,
including surgically correctable forms,
in centers from five continents.
J Clin Endocrinol Metab 2004; 89:1045-1050
Magill SB,
Raff H,
Shaker JL,
and et al.
Comparison of adrenal vein sampling and computed tomography in the differentiation of primary aldosteronism.
J Clin Endocrinol Metab 2001; 86:1066-1071
Eapriner EA,
Ross DG,
Yandle TG,
Richards AM,
Hunt PJ
Predicting surgically remedial primary aldosteronism: role of adrenal scanning,
posture testing,
and adrenal vein sampling.
J Clin Endocrinol Metab...