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... On the other hand, AVS is not needed in individuals who prefer medical therapy and in those who are not suitable for surgery due to comorbidities or age. 21,42 A simple clinical prediction criterion could probably identify some patients with bilateral primary aldosteronism who should avoid unnecessary AVS and be treated medically. 18 Last but not least, the primary aldosteronism surgical outcome predictor might help finding patients who are expected to attain long-term blood pressure control after adrenalectomy to guide preoperative patient counseling and final decision for or against AVS and surgery. ...
Background
Adrenal vein sampling (AVS) is essential for diagnostics of primary aldosteronism, distinguishing unilateral from bilateral disease and determining treatment options. We reviewed the performance of AVS for primary aldosteronism at our center during first 15 years, comparing the initial period to the period after the introduction of a dedicated radiologist. Additionally, AVS outcomes were checked against CT findings and the proportion of operated patients with proven unilateral disease was estimated.
Patients and methods
A retrospective cross-sectional study conducted at the national endocrine referral center included all patients with primary aldosteronism who underwent AVS after its introduction in 2004 until the end of 2018. AVS was performed sequentially during Synacthen infusion. When the ratio of cortisol concentrations from adrenal vein and inferior vena cava was at least 5, AVS was considered successful.
Results
Data from 235 patients were examined (168 men; age 32–73, median 56 years; BMI 18–48, median 30.4 kg/ m ² ). Average number of annual AVS procedures increased from 7 in the 2004–2011 period to 29 in the 2012–2018 period ( p < 0.001). AVS had to be repeated in 10% of procedures; it was successful in 77% of procedures and 86% of patients. The proportion of patients with successful AVS (92% in 2012–2018 vs . 66% in 2004–2011, p < 0.001) and of successful AVS procedures (82% vs . 61%, p < 0.001) was statistically significantly higher in the recent period.
Conclusions
Number of AVS procedures and success rate at our center increased over time. Introduction of a dedicated radiologist and technical advance expanded and improved the AVS practice.
... Čeprav je delež teh bolnikov le okoli 10 %, je pomembno, da jih prepoznamo, saj gre za popravljivo stanje, ki ga lahko dokončno ozdravimo, če odpravimo vzrok (3). Najpogostejši vzrok sekundarne hipertenzije je verjetno primarni aldosteronizem (PA) (4). ...
... Vrednosti nad 4 govorijo za enostransko obliko PA (10). AVS je invazivna, tehnično zahtevna in draga diagnostična preiskava, vendar je zaradi svoje visoke občutljivosti in specifičnosti zlati standard za razlikovanje med obema glavnima oblikama PA (4,5). Če z AVS zanesljivo dokažemo enostransko bolezen, z laparoskopsko adrenalektomijo popolnoma normaliziramo KT pri približno 40 % bolnikov, pri veliki večini ostalih pa vodenje AH bistveno olajšamo. ...
... Če je bolnik s PA kandidat za kirurško zdravljenje, je tako za dokaz enostranskega čezmernega izločanja aldosterona običajno potrebno opraviti AVS (4). Izjema so bolniki, mlajši od 35 let, s spontano hipokaliemijo, izrazitim presežkom aldosterona in s CT vidno enostransko spremembo z radiološkimi značilnostmi adenoma, pri katerih naj bi bil glede na raziskave izvid CT vedno skladen z izvidi AVS (4,5). Naš bolnik je bil v letu 2004 star že 42 let, zato je bila AVS ustrezna preiskava. ...
Predstavljamo bolnika s tumorjem leve nadledvičnice, ki je bil vrsto let obravnavan zaradi odporne hipertenzije in hipokaliemije. Potrjen je bil izrazit primarni aldosteronizem, vendar kljub večkratnim poskusom s selektivno kateterizacijo nadledvičnih ven enostranske bolezni nismo uspeli dokazati. Z antagonisti mineralokortikoidnih receptorjev bolezni nismo uspeli obvladati, trdne osnove za operativno zdravljenje pa tudi ni bilo. Klinične in laboratorijske značilnosti bolnika so govorile za enostransko bolezen, zato smo ga napotili še na PET CT z 11-C-metomidatom v Veliko Britanijo. Tako smo dokazali enostransko bolezen in bolnika ozdravili z levostransko laparoskopsko adrenalektomijo.
