PDF herunterladen
Rofo 2021; 193(06): 658-666
DOI: 10.1055/a-1299-1878
Review

Update: Selective adrenal venous sampling (AVS) – Indication, technique, and significance

Artikel in mehreren Sprachen: English | deutsch
Christina Loberg
1   University Dusseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, Dusseldorf, Germany
,
Gerald Antoch
1   University Dusseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, Dusseldorf, Germany
,
Johannes Stegbauer
2   Department of Nephrology, Medical Faculty, Heinrich‐Heine‐University Düsseldorf, Düsseldorf, Germany
,
Till Dringenberg
3   Division for Specific Endocrinology, University Hospital Düsseldorf, Düsseldorf, Germany
,
Andrea Steuwe
1   University Dusseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, Dusseldorf, Germany
,
Günter Fürst
1   University Dusseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, Dusseldorf, Germany
,
Matthias Haase
3   Division for Specific Endocrinology, University Hospital Düsseldorf, Düsseldorf, Germany
,
Lars Christian Rump
2   Department of Nephrology, Medical Faculty, Heinrich‐Heine‐University Düsseldorf, Düsseldorf, Germany
,
Lars Schimmöller 
1   University Dusseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, Dusseldorf, Germany
› Institutsangaben
› Weitere Informationen
Auch verfügbar auf
   Lizenzen und Reprints

Abstract

Background Primary aldosteronism (PA) is the most common detectable cause of secondary hypertension. The majority of patients have either an adrenal aldosterone-producing adenoma (APA) or bilateral adrenal hyperplasia (BAH) demanding different therapeutic approaches. Screening tests and imaging cannot reliably distinguish between a unilateral or bilateral PA.

Methods This review article gives an overview concerning etiology, diagnostics, and therapeutic options of PA, and reviews the indication, the technique, and relevance of selective adrenal venous sampling (AVS) in the context of the current literature and the authors’ experience.

Results AVS can verify or exclude a unilaterally dominated secretion with a high success rate. Patients with PA and a unilateral APA can be treated curatively by adrenalectomy.

Conclusions AVS is an established diagnostic examination for differentiation of unilateral from bilateral adrenal disease in patients with PA.

Key Points:

  • Selective adrenal venous sampling (AVS) is a safe, reliable, and minimally invasive method to detect a unilateral or bilateral adrenal adrenal gland disease.

  • Verification of lateralization by AVS has direct therapeutic relevance for patients with primary aldosteronism (PA).

  • AVS can be performed with low radiation exposure, without contrast medium, and with a high success rate when performed by an experienced interventional radiologist.

Citation Format

  • Loberg C, Antoch G, Stegbauer J et al. Update: Selective adrenal venous sampling (AVS) – Indication, technique, and significance. Fortschr Röntgenstr 2021; 193: 658 – 666

Key words

adrenal gland - interventional procedures - angiography - blood - hypertension


Publikationsverlauf

Eingereicht: 03. Juli 2020

Angenommen: 19. Oktober 2020

Artikel online veröffentlicht:
16. Dezember 2020

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Rossi GP, Bernini G, Caliumi C. et al. A prospective study of the prevalence of primary aldosteronism in 1125 hypertensive patients. J Am Coll Cardiol 2006; 48: 2293-2300
    CrossrefPubMedGoogle Scholar
  • 2 Douma S, Petidis K, Doumas M. et al. Prevalence of primary hyperaldosteronism in resistant hypertension: a retrospective observational study. Lancet 2008; 371: 1921-1926
    CrossrefPubMedGoogle Scholar
  • 3 Young WF. Primary aldosteronism: renaissance of a syndrome. Clin Endocrinol 2007; 66: 607-618
    CrossrefPubMedGoogle Scholar
  • 4 Heinrich DA, Adolf C, Rump LC. et al. Primary Hyperaldosteronism: key characteristics at diagnosis: a trend toward milder forms. Eur J Endocrinol 2018; 178: 605-611
    CrossrefPubMedGoogle Scholar
  • 5 Martell-Claros N, Abad-Cardiel M, Alvarez-Alvarenz B. et al. Primary aldosteronism and its various clinical scenarios. J Hypertens 2015; 33: 1226-1232
    CrossrefPubMedGoogle Scholar
  • 6 Funder JW, Carey RM, Mantero F. et al. The Management of Primary Aldosteronism: Case Detection, Diagnosis, and Treatment: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab 2016; 101: 1889-1916
    CrossrefPubMedGoogle Scholar
  • 7 Prejbisz A, Warchol-Celinska E, Lenders JW. et al. Cardiovasc. Risk in Primary Hyperaldosteronism. Horm Metab Res 2015; 47: 973-980
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 8 Rossi GP, Seccia TM, Maiolino G. et al The cardiovasculars consequences of hyperaldosteronism. Ann Endocrinol 2020 [online first]
    Google Scholar
  • 9 Pillai PR, Griffith M, Schwarcz MD. et al. Primary Hyperaldosteronism: Cardiovasc. Risk, Diagnosis and Management. Cardiol Rev 2020; 28: 84-91
    CrossrefPubMedGoogle Scholar
  • 10 Terzolo M, Stigliano A, Chiodini I. et al. AME position statement on adrenal incidentaloma. Eur J Endocrinol 2011; 164: 851-870
    CrossrefPubMedGoogle Scholar
  • 11 Chiloiro S, Giampietro A, Raffaelli M. et al. Synchronous bilateral adrenalectomy in ACTH-dependent hypercortisolism: predictors, biomarkers and outcomes. Endocrine 2019; 66: 642-649
    CrossrefPubMedGoogle Scholar
  • 12 Vonend O, Quack I, Rump LR. Aldosteron und Hypertonie. Wien klin Wochenschr 2010; 122: 65-74
    CrossrefPubMedGoogle Scholar
  • 13 Song Y, Yang S, He W. et al. Confirmatory Tests for the Diagnosis of Primary Hyperaldosteronism: A Prospective Diagnostic Accuracy Study. Chonquing Primary Aldosteronism Study (CONPASS) Group. Hypertension 2018; 71: 118-124
    CrossrefPubMedGoogle Scholar
  • 14 Delivanis DA, Vassiliadi DA, Tsagarakis S. Adrenal Imaging in Patients with Endocrine Hypertension. Endocrinol Metab Clin N Am 2019; 48: 667-680
    CrossrefPubMedGoogle Scholar
  • 15 Boland GW, Lee MJ, Gazelle GS. et al. Characterization of adrenal masses using unenhanced CT: an analysis of the CT literature. Am J Roentgenol 1998; 171: 201-204
    CrossrefPubMedGoogle Scholar
  • 16 Korobkin M, Brodeur FJ, Francis IR. et al. CT Time – attenuation washout curves of adrenal adenoma s and nonadenomas. Am J Roentgenol 1998; 170: 747-752
    CrossrefPubMedGoogle Scholar
  • 17 Seo JM, Park BK, Park SY. et al. Characterization of lipid – poor adrenal adenoma: chemical shift MRI and wash-out CT. Am J Roentgenol 2014; 202: 1043-1050
    CrossrefPubMedGoogle Scholar
  • 18 Siegelman ES. Adrenal MRI: Techniques and clinical applications. L Magn Reson Imaging 2012; 36: 272-285
    CrossrefPubMedGoogle Scholar
  • 19 Stowasser M, Gordon RD, Rutherford JC. et al. Diagnosis and management of primary aldosteronism. J Renin Angiotensin Aldosterone Syst 2001; 2: 156-169
    CrossrefPubMedGoogle Scholar
  • 20 Blondin D, Quark I, Haase M. et al. Indikationen und Technik der selektiven Nebennierenvenenblutentnahme. RöFo 2015; 187: 19-28
    PubMedGoogle Scholar
  • 21 England RW, Geer EB, Deipolyi AR. Role of Venous Sampling in the Diagnosis of Endocrine Disorders. J Clin Med 2018; 7: 114
    CrossrefPubMedGoogle Scholar
  • 22 Yeh MW, Duh QY. Chapter 41: The Adrenal Glands. In: Townsend CM. Sabiston Textbook Of Surgery. Sauders: Elsevier; 2008. Available on https://thoracickey.com/the-adrenal-glands/
    Google Scholar
  • 23 Cesmebasi A, Du Plessis M, Iannatuono M. et al. A review of the anatomy and clinical significance of adrenal veins. Clin Anat 2014; 27: 1253-1263
    CrossrefPubMedGoogle Scholar
  • 24 Patel IJ, Davidson JC, Nikolic B. et al. Consensus Guidelines for Periprocedural Management of Coagulation Status and Hemostasis Risk in percutaneous Image-guides Interventions. JVIR 2019; 30: 1168-1184
    CrossrefPubMedGoogle Scholar
  • 25 Mailhot JP, Traistaru M, Soulez G. et al. Adrenal Vein Sampling in Primary Hyperaldosteronism: Sensitivity and Specificity of Basal Cortisol and Aldosterone Ratios to Confirm Cathererization of the Adrenal Vein. Radiology 2015; 277: 887-894
    CrossrefPubMedGoogle Scholar
  • 26 Ueland GA, Methlie P, Jøssang DE. et al. Adrenal Venous Sampling for Assessment of Autonomous Cortisol Secretion. J Clin Endocrinol Metab 2018; 103: 4553-4560
    CrossrefPubMedGoogle Scholar
  • 27 Rossi GP, Auchus RJ, Brown M. et al. An expert consensus statement on use of adrenal vein sampling for the subtyping of primary aldosteronism. Hypertension 2014; 63: 151-160
    CrossrefPubMedGoogle Scholar
  • 28 Kahn SL, Angle FJ. Adrenal Vein Sampling. Tech Vasc Interv Radiol 2010; 13: 110-125
    CrossrefPubMedGoogle Scholar
  • 29 Satani N, Ota H, Seiji K. et al. Intra-adrenal aldosterone secretion: Segmental adrenal venous sampling for localization. Radiology 2016; 278: 265-274
    CrossrefPubMedGoogle Scholar
  • 30 Daunt N. Adrenal Vein Sampling: How to Make It Quick, Easy, and Successful. RadioGraphics 2005; 25: 143-158
    CrossrefPubMedGoogle Scholar
  • 31 Doppmann JL, Gill JR. Hyperaldosteronism: Sampling the Adrenal Veins. Radiology 1996; 198: 309-312
    CrossrefPubMedGoogle Scholar
  • 32 Cesari M, Ceolotto G, Rossitto G. et al. The Intra-Procedural Cortisol Assay During Adrenal Vein Sampling: Rationale and Design of a Randomized Study (I-Padua). High Blood Press Cardiovasc Pre 2017; 24: 167-170
    CrossrefPubMedGoogle Scholar
  • 33 Funder JW, Carey RM, Mantero F. et al. The Management of Primary Aldosteronism:Case Detection, Diagnosis, and Treatment:An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab 2016; 101: 1889-1916
    CrossrefPubMedGoogle Scholar
  • 34 Rossi GP, Barisa M, Allolio B. et al. The adrenal vein sampling international study AVIS for identifying the major subtypes of primary aldosteronism. J Clin Endocrinol Metab 2012; 97: 1606-1614
    CrossrefPubMedGoogle Scholar
  • 35 Monticone S, Satoh F, Dietz AS. et al. Clinical Management and Outcomes of adrenal Hemorrhage Following Adrenal Vein Sampling in Primary hyperaldosteronism. Hypertension 2016; 67: 146-152
    CrossrefPubMedGoogle Scholar
  • 36 Lim V, Guo Q, Grant CS. et al. Accuracy of adrenal imaging and adrenal venous sampling in predicting surgical cure of primary aldosteronism. J Clin Endocrinol Metab 2014; 99: 2712-2719
    CrossrefPubMedGoogle Scholar
  • 37 Vonend O, Ockenfels N, Gao X. et al. Adrenal venous sampling: evaluation of the German Conn’s registry. Hypertension 2011; 57: 990-995
    CrossrefPubMedGoogle Scholar
  • 38 Fuss CT, Treitl M, Rayes N. et al. Radiation exposure of adrenal vein sampling: a German Multicenter Study. Eur J Endocrinol 2018; 179: 261-267
    CrossrefPubMedGoogle Scholar
  • 39 Lupi A, Battistel M, Barbiero G. et al. Simultaneous bilateral adrenal vein sampling for primary aldosteronism: useful tips to make it simple and safe. Eur Radiol 2019; 11: 6330-6335
    CrossrefPubMedGoogle Scholar
  • 40 Noda Y, Goshima S, Nagata S. et al. Utility of microcatheter in adrenal venous sampling for primary aldosteronism. Br J Radiol 2020; 93: 1109
    CrossrefPubMedGoogle Scholar
  • 41 Rossitto G, Maiolino G, Lenzini L. et al. Subtyping of primary aldosteronism with adrenal vein sampling: Hormone- and side-specific effects of cosyntropin and metoclopramide. Surgery 2018; 163: 789-795
    CrossrefPubMedGoogle Scholar
  • 42 Kline GA, So B, Dias VC. et al. Catheterization during adrenal vein sampling for primary aldosteronism: failure to use (1–24) ACTH may increase apparent failure rate. J Clin Hypertens (Greenwich) 2013; 15: 480-484
    CrossrefPubMedGoogle Scholar
  • 43 Deinum J, Groenewoud H, van der Wilt GJ. et al. Adrenal venous sampling: cosyntropin stimulation or not?. Eur J Endocrin 2019; 181: D15-D26
    CrossrefPubMedGoogle Scholar
  • 44 Onozawa S, Murata S, Tajima H. et al. Evaluation of right adrenal vein cannulation by computed tomography angiography in 140 consecutive patients undergoing adrenal venous sampling. Eur J Endocrinol 2014; 170: 601-608
    CrossrefPubMedGoogle Scholar
  • 45 Meyrignac O, Arcis É, Delchier MC. et al Impact of cone beam CT on adrenal vein sampling in primary aldosteronism. Eur J Radiol 2020; 124 [online first]
    Google Scholar
  • 46 Ladurner R, Sommerey S, Buechner S. et al. Accuracy of adrenal imaging and adrenal venous sampling in diagnosing unilateral primary aldosteronism. Eur J Clin Invest 2017; 47: 372-377
    CrossrefPubMedGoogle Scholar
  • 47 Dekkers T, Prejbisz A, Kool LJ. et al. Adrenal vein sampling versus CT scan to determine treatment in primary aldosteronism: An outcome-based randomised diagnostic trial. Lancet Diabetes Endocrinol 2016; 4: 739-746
    CrossrefPubMedGoogle Scholar
  • 48 Beuschlein F, Mulatero P, Asbach E. et al. The SPARTACUS Trial: Controversies and Unresolved Issues. Horm Metab Res 2017; 49: 936-942
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 49 Sk2-Leitlinie Operative Therapie von Nebennierentumoren. Langversion; Dezember 2017; AWMF-Register-Nummer: 088/008. https://www.awmf.org/leitlinien/detail/ll/088-008.html (Zugriff am: 22.08.2020)
    Google Scholar
  • 50 Tomaschitz A, Dobnig H. Primärer Hyperaldosteronismus – die häufigste monokausale Ursache der essenziellen Hypertonie. J Clin Endocrinology and Metabolism 2009; 2: 14-21
    PubMedGoogle Scholar
  • 51 Vorselaars WMCM, Nell S, Postma EL. et al. Clinical Outcomes After Unilateral Adrenalectomy for Primary Aldosteronism. JAMA Surg 2019; 154: e185842
    CrossrefPubMedGoogle Scholar
  • 52 Liang KW, Jahangiri Y, Tsao TF. et al. Effectiveness of Thermal Ablation for Aldosterone-Producing Adrenal Adenoma: A Systematic Review and Meta-Analysis of Clinical and Biochemical Parameters. J Vasc Interv Radiol 2019; 30: 1335-1342
    CrossrefPubMedGoogle Scholar