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Horm Metab Res 2010; 42(6): 411-415
DOI: 10.1055/s-0030-1252060
Review

© Georg Thieme Verlag KG Stuttgart · New York

What We Still do not Know About Adrenal Vein Sampling for Primary Aldosteronism

R. J. Auchus1 , F. H. Wians2  Jr , M. E. Anderson3 , B. L. Dolmatch3 , C. K. Trimmer3 , S. C. Josephs3 , D. Chan3 , S. Toomay3 , F. E. Nwariaku4
  • 1Division of Endocrinology and Metabolism, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, USA
  • 2Department of Pathology, UT Southwestern Medical Center, Dallas, TX, USA
  • 3Vascular and Interventional Radiology, Department of Radiology, UT Southwestern Medical Center, Dallas, TX, USA
  • 4Division of Gastrointestinal and Endocrine Surgery, Department of Surgery, UT Southwestern Medical Center, Dallas, TX, USA
Further Information

Publication History

received 19.10.2009

accepted 23.03.2010

Publication Date:
21 April 2010 (online)

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Abstract

During the last two decades, primary aldosteronism has emerged as the most common cause of secondary hypertension, and advances in the diagnosis and treatment of this condition have improved patient care substantially. A major stumbling block in the evaluation and management of these patients, which ultimately guides treatment and prognosis, is answering the question, “Which adrenal gland(s) produce aldosterone?” Adrenal vein sampling has emerged as the only reliable method to determine the answer to this question; however, the methodology and criteria for lateralization have been determined empirically with little prospective data. The major remaining controversies surrounding adrenal vein sampling include: who should perform and who should undergo the procedure; what criteria should be used to define a successful study and lateralization of aldosterone production; whether cosyntropin should be infused during the procedure and how; and what to do when results are ambiguous? This article reviews some of the advances in the execution of this procedure, the variations in procedure, the data that fuel the controversies, and the issues that need to be resolved in the future.

Key words

adrenal adenoma - aldosterone - mineralocorticoid - steroid hormones - renin-angiotensin-aldosterone systems

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Correspondence

R. J. AuchusMD, PhD 

Division of Endocrinology

and Metabolism

Department of Internal Medicine

UT Southwestern Medical

Center

5323 Harry Hines Blvd

TX 75390-8857 Dallas

USA

Phone: +1 214 648 6751

Fax: +1 214 648 8917

Email: richard.auchus@UTSouthwestern.edu

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