Role of Adrenal Vein Sampling in Guiding Surgical Decision in Primary Aldosteronism
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.
- Location
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Deutsche Nationalbibliothek Frankfurt am Main
- Extent
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Online-Ressource
- Language
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Englisch
- Bibliographic citation
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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
- Contributor
- DOI
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10.1055/a-2106-4663
- URN
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urn:nbn:de:101:1-2023092811034491640434
- Rights
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Kein Open Access; Der Zugriff auf das Objekt ist unbeschränkt möglich.
- Last update
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14.08.2025, 11:02 AM CEST
Data provider
Deutsche Nationalbibliothek. If you have any questions about the object, please contact the data provider.
Associated
- Younes, Nada
- Larose, Stphanie
- Bourdeau, Isabelle
- Therasse, Eric
- Lacroix, André
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Effect of Adrenocorticotropic Hormone Stimulation During Simultaneous Bilateral Adrenal Vein Sampling in Primary Aldosteronism
Feasibility and effectiveness of a single-catheter approach for adrenal vein sampling in patients with primary aldosteronism
Adrenal Vein Sampling: How I Do It
[11C]metomidate PET-CT versus adrenal vein sampling for diagnosing surgically curable primary aldosteronism: a prospective, within-patient trial
Combined Efficacy of Adrenal Vein Sampling and Imaging Findings in Predicting Clinical Outcomes Following Unilateral Adrenalectomy for Primary Aldosteronism
Identifying primary aldosteronism patients who require adrenal venous sampling: a multi-center study
Adrenal vein sampling: technique and protocol, a systematic review
Adrenal Vein Sampling: Does the Location of the Non-adrenal Venous Sample Matter?
Adrenal Vein Sampling: Radiation Dose Reduction on New Angiography Platform
Cost-effectiveness analysis of segmental adrenal venous sampling with radiofrequency ablation for primary aldosteronism in Japan
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