Type:
Educational Exhibit
Keywords:
Hypertension, Endocrine disorders, Sampling, Computer Applications-3D, CT-Quantitative, CT, Catheter venography, Veins / Vena cava, Interventional vascular, Kidney
Authors:
K. Takase, K. Seiji, M. Tsuda, H. Ota, S. Takahashi; Sendai/JP
DOI:
10.1594/ecr2012/C-1343
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.
Fig. 1
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.
Fig. 2
CT is not reliable in subtype diagnosis of primary aldosteronism
Morphological diagnosis by MDCT is not reliable in diagnosing the side of aldosterone hypersecretion because aldosterone may be produced in the contrarateral side of the CT visible adrenal adenoma.
Fig. 3
Fig. 4
Presence of non-CT visible aldosterone producing microadenoma
Fig. 5
Fig. 6
Therefore,
selective adrenal venous sampling is crucial.
However,
success rate was generally low (around 70% in previous reports)because of variation of small right adrenal venous anatomy and presence of small accessory hepatic veins which simulate the right adrenal vein.
Fig. 7