Introduction: Primary Hyperaldosteronism (PH) is a condition of excess of aldosterone production and occurs secondary to adrenal cortical adenoma, bilateral adrenal hyperplasia, or rarely, adrenal carcinoma. In some cases of PH, adrenal venous sampling (AVS) is considered mandatory to differentiate between unilateral and bilateral adrenal disease, to decide whether the patient will benefit from unilateral adrenalectomy (AE).
Mainly due to technical difficulties and lack of experience this procedure is not commonly performed.
Aim: To share our experience with AVS.
Methods: Five patients underwent AVS. All had screening and confirmatory test consistent with PH, but with doubt as to surgical treatment. CTV of the abdomen was performed before AVS, to identify venous anatomy.
During AVS, both adrenal vein were sequentially catheterized during continuous ACTH infusion and sampling simultaneous with peripheral blood. Successful adrenal vein cannulation was confirmed based on selectivity index >5 (adrenal/peripheral vein cortisol concentration ratio >5). We used lateralization index (LI)>4 to identify unilateral disease.
Results: Two patients with positive LI were referred to unilateral AE: The first is a 42 y.o. male, with a 24 mm Rt. adrenal mass and only mild LT adrenal hyperplasia, but following AVS lateralization he underwent Lt. AE. The second is a 55 y.o. male, with a small 13 mm Lt. adrenal adenoma. We were uncertain upon surgery based on morphology alone. After AVS lateralization however, we were definite regarding Lt. AE. In both patients after surgery, hypokalemia resolved and hypertension significantly improved.
Two patients (57 and 62 y.o), with negative lateralization on AVS had not been referred to surgery despite having 10-15 mm unilateral adenomas. In one 62 y.o male, catheterization of the right adrenal vein failed. No complications were observed.
Summary: Our initial experience shows that AVS can be done successfully with no complications. In some cases AVS can help clinicians choose the appropriate treatment.
