Endocrine Abstracts

Introduction: Unilateral aldosterone hypersecretion can be adequately treated based on the localization by adrenal venous sampling. However, bilateral aldosterone producing adenoma or primary aldosteronism with preclinical Cushing syndrome cannot be treated with simple unilateral adrenalectomy. Diagnosis of intra-adrenal localization of aldosterone hypersecretion is necessary for surgical treatment of these types of primary aldosteronism.

Method: From 2009 to 2011, we performed superselective adrenal sampling of 68 patients with primary aldosteronism. A 6.5-Fr catheter was inserted from the left femoral vein to select the orifice of the left adrenal vein. Then a 6.5-Fr catheter designed for various types of right adrenal vein (“Adselect series”, Hanako medical, Tokyo, Japan) was inserted from the right femoral vein into the right adrenal vein. MDCT information was used as a reference of catheter manipulations. Simultaneous venous sampling was repeated 15 minutes after intravenous one-shot injection of the 0.25 mg of ACTH. Then superselective adrenal venous sampling was performed by catheterization into each 3 tributaries of bilateral adrenal vein using high-fro-type microcatheter.

Results: In all cases, superselecive adrenal venous sampling was successfully perfrmed. In 27 cases, unilateral aldosterone hypersecretion was diagnosed, followed by unilateral adrenalectomy. Superselective sampling provides very high absolute concentration of aldosterone in at least one adrenal venous tributary of unilateral adrenal gland, confirming the diagnosis of aldosterone producing adenoma. In 4 cases, bilateral aldosterone hypersecretion with normal aldosterone level in at least one tributary was diagnosed showing bilateral aldosterone producing adenoma, which enabled surgical treatment of unilateral total adrenarectomy combined with contrarateral partial adrenarectomy. In the remaining 37 cases, blood sample from all the tributaries of bilateral adrenal vein showed high aldosterone concentration showing idiopathic hyperaldosteronism, followed by medical treatment.

Conclusion: Superselective adrenal venous sampling allows primary aldosteronism with bilateral aldosterone producing adenoma treated by surgery.

Bilateral superselective adrenal venous sampling. Blood were sampled from 9 points shown in the figure. Intra-adrenal localization of aldosterone hypersecretion could be diagnosed: bilateral aldosterone hypersecretion with normal aldosterone content in one of the tributaries. This patient could be treated by unilateral total adrenarectomy combined with contralateral partial adrenarectomy.

Declaration of interest: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.

Funding: This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.