Role of Adrenal Vein Sampling in Guiding Surgical Decision in Primary Aldosteronism

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Abstract: Adrenal vein sampling (AVS) is recommended for subtyping primary aldosteronism (PA) to identify lateralized or bilateral sources of aldosterone excess, allowing for better decision-making in regard to medical or surgical management on a case-by-case basis. To date, no consensus exists on protocols to be used during AVS, especially concerning sampling techniques, the timing of sampling, and whether or not to use adrenocorticotropic hormone (ACTH) stimulation. Interpretation criteria for selectivity, lateralization, and contralateral suppression vary from one expert center to another, with some favoring strict cut-offs to others being more permissive. Clinical and biochemical post-operative outcomes can also be influenced by AVS criteria utilized to indicate surgical therapy. In this review, we reanalyze studies on AVS highlighting the recent pathological findings of frequent micronodular hyperplasia adjacent to a dominant aldosteronoma (APA) overlapping with bilateral idiopathic hyperaldosteronism (IHA) etiologies, as opposed to the less frequent unilateral single aldosteronoma. The variable expression of melanocortin type 2 receptors in the nodules and hyperplasia may explain the frequent discordance in lateralization ratios between unstimulated and ACTH- stimulated samples. We conclude that aldosterone values collected during simultaneous bilateral sampling, both at baseline and post-ACTH stimulation, are required to adequately evaluate selectivity, lateralization, and contralateral suppression during AVS, to better identify all patients with PA that can benefit from a surgical indication. Recommended cut-offs for each ratio are also presented.

Standort
Deutsche Nationalbibliothek Frankfurt am Main
Umfang
Online-Ressource
Sprache
Englisch

Erschienen in
Role of Adrenal Vein Sampling in Guiding Surgical Decision in Primary Aldosteronism ; volume:131 ; number:07/08 ; year:2023 ; pages:418-434
Experimental and clinical endocrinology & diabetes ; 131, Heft 07/08 (2023), 418-434

Beteiligte Personen und Organisationen
Younes, Nada
Larose, Stphanie
Bourdeau, Isabelle
Therasse, Eric
Lacroix, André

DOI
10.1055/a-2106-4663
URN
urn:nbn:de:101:1-2023092811034491640434
Rechteinformation
Kein Open Access; Der Zugriff auf das Objekt ist unbeschränkt möglich.
Letzte Aktualisierung
14.08.2025, 11:02 MESZ

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Beteiligte

  • Younes, Nada
  • Larose, Stphanie
  • Bourdeau, Isabelle
  • Therasse, Eric
  • Lacroix, André

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