Role of Adrenal Venous Sampling in the Treatment Strategy for Primary Aldosteronism

Yi-San Tsai ； Vincent P. Chuang ； Chao-Chun Chen ； Ya Ling Hsu ； Li-Ying Juan ； Sing Lian Lee ； Gerald J.S. Tsai ； Jeffrey C. Chen

《Formosan Journal of Endocrinology and Metabolism》 2卷2期 (2011/04) Pp. 38-43

https://doi.org/10.6856/FJEM.201104_2(2).0002

摘要

Among the general hypertensive population, the prevalence rate of primary aldosteronism (PA) has risen dramatically from the previously believed 1% to as high as 10% or more. The same trend was also reported in an Asian population from a recent study in Singapore. In the presence of hyporeninemic hyperaldosteronism, aldosterone-producing adenoma and unilateral adrenal hyperplasia representing as unilateral adrenal causes account for 35% and 2% of cases, respectively, whereas idiopathic hyperaldosteronism with a bilateral adrenal disease comprises 60% of cases. Unilateral disease differs completely from the bilateral entity in that the former is surgically curable, and the failure of recognition of the latter would result in unnecessary adrenalectomy in approximately 15-25% of cases. Adrenal venous sampling (AVS) has an absolute superiority as compared to adrenal computed tomography in distinguishing between unilateral and bilateral source of primary aldosteronism: the sensitivity is 95% vs 78%, respectively, and the specificity is 100% vs 75%, respectively. Accordingly, AVS should be the standard reference diagnostic tool to guide the clinician in the decision of the appropriate treatment modality. Through a successful experience of AVS in a single institution, this report aims to highlight the fundamental importance of performing AVS, overcoming its well-known technical difficulties, and eventually promoting its greater use in the treatment strategy of PA, the most common cause of endocrine hypertension.

關鍵字

adrenal venous sampling ； primary aldosteronism ； aldosterone-to-renin ratio ； aldosterone