Endocrine Abstracts

Primary hyperaldosteronism is a common cause of secondary hypertension. Distinguishing between the two subtypes (unilateral aldosterone-producing adenoma and bilateral idiopathic hyperaldosteronism) is crucial for patient’s management. Adrenal venous sampling is an important method for evaluation of the condition, but selective successful right adrenal venous sampling is often reported to be a difficult procedure. A retrospective review of 51 cases suffering from primary hyperaldosteronism with adrenal venous sampling done in the year of 2007 to 2010 in our local hospital in Hong Kong was performed. Biochemical assay of both cortisol and aldosterone levels were done in each sample. Cortisol gradient of 3 between the adrenal sample and a peripheral sample was set as a criterion to indicate successful sampling. Successful catheterizations of the right adrenal vein were noted in 40 cases, while 11 cases failed to meet the cortisol gradient and were excluded. Of the cases fulfilling the cortisol gradient criterion, it was observed that the first sample taken was most useful in analysis of aldosterone–cortisol ratio. Five different patterns of the right adrenal vein were previously described. The right adrenal vein patterns of our patients were as follows: 42.5% with central vein leading to stellate or spidery branches, 27.5% with delta pattern, 10% with glandlike pattern, 7.5% with no discernable adrenal vessels, 2.5% with triangular pattern, and 10% showed vasculatures not typical of these five patterns. Central vein leading to stellate or spidery branches is the commonest pattern, which may differ from those in Caucasians. Identification of these patterns during the interventional procedure may give radiologists a high confidence level that the cannulation is successful, facilitating efficient and precise sampling.

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 work was supported, however funding details unavailable.