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What is the Best Criterion for the Interpretation of Adrenal Vein Sample Results in Patients with Primary Hyperaldosteronism?

  • Endocrine Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

In patients with primary hyperaldosteronism, adrenal vein sampling (AVS) has emerged as a gold standard for distinguishing between unilateral and bilateral disease, but multiple criteria have been used and no consensus exists as to the most accurate criterion. The objective of this study was to determine which AVS criteria most accurately identify patients with unilateral surgical disease and are associated with significant clinical improvement after adrenalectomy.

Methods

This is a retrospective analysis of AVS results in 108 patients with primary hyperaldosteronism treated at a single institution. Literature review of AVS criteria was used to distinguish between unilateral and bilateral disease.

Results

Of the 10 AVS criteria identified in the literature, one criterion (ACTH stimulation, positioning: cortisol [adrenal]/cortisol [periphery] [Ca/Cp] > 5.0 and lateralization: aldosterone/cortisol [A/C] [dominant {D}]: A/C [nondominant {ND}] > 4:1) was the most accurate in identifying and correctly predicting lateralization of disease (P value range: < 0.001–0.0369). For this criterion, the true positive rate was 88%. The second most accurate criterion was no ACTH stimulation, positioning Ca/Cp > 1.1 and lateralization: A/C (D): A/C (ND) > 2:1. For this criterion, the overall true positive was 85%. However, we found no significant difference in clinical outcome based on individual criteria fulfillment.

Conclusions

Of the multiple criteria used for AVS evaluation, one criterion has the best accuracy. With the increasing use of AVS, there should be a consensus by which these results are evaluated and surgeons recommend adrenalectomy.

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Authors and Affiliations

  1. Endocrine Oncology Section, Surgery Branch, National Cancer Institute, Bethesda, MD, USA

    Richard Webb MD, Aarti Mathur MD, Naris Nilubol MD & Electron Kebebew MD

  2. Department of Diagnostic Radiology, Warren F Magnuson Clinical Center, Bethesda, MD, USA

    Richard Chang MD

  3. Program in Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institutes of Child Health and Human Development (NICHD), Bethesda, MD, USA

    Smita Baid MD & Constantine A. Stratakis MD, D(Med)Sci

  4. Department of Surgery, Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY, USA

    Steven K. Libutti MD

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  1. Richard Webb MD
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  2. Aarti Mathur MD
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  3. Richard Chang MD
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  4. Smita Baid MD
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  5. Naris Nilubol MD
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  7. Constantine A. Stratakis MD, D(Med)Sci
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  8. Electron Kebebew MD
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Correspondence to Electron Kebebew MD.

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Webb, R., Mathur, A., Chang, R. et al. What is the Best Criterion for the Interpretation of Adrenal Vein Sample Results in Patients with Primary Hyperaldosteronism?. Ann Surg Oncol 19, 1881–1886 (2012). https://doi.org/10.1245/s10434-011-2121-5

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  • DOI: https://doi.org/10.1245/s10434-011-2121-5

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