Are catecholamine-derived indexes in adrenal venous sampling useful for judging selectivity and laterality in patients w
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ORIGINAL ARTICLE
Are catecholamine-derived indexes in adrenal venous sampling useful for judging selectivity and laterality in patients with primary aldosteronism? Yasutaka Baba • Sadao Hayashi • Masayuki Nakajo
Received: 18 June 2012 / Accepted: 4 September 2012 / Published online: 19 September 2012 Ó Springer Science+Business Media, LLC 2012
Abstract In order to investigate retrospectively whether catecholamine concentrations obtained by adrenal venous sampling (AVS) are useful for lateralization of the aldosteronoma-bearing adrenal gland. The study population comprised 35 patients (10 men, 25 women; mean age, 49.8 years) with aldosteronoma and 18 patients (9 men, 9 women; mean age, 51.8 years) with non-functioning adenoma who underwent AVS between 1994 and 2010. In all cases, AVS was performed without administering adrenocorticotrophic hormone. Successful or unsuccessful adrenal vein blood sampling (selectivity) was judged by the ratio of plasma cortisol (C) level in each adrenal vein to that in the infra-renal inferior vena cava [C(side)/C(IVC)] as a gold standard, with successful selectivity defined using four different cut-off values [C(side)/C(IVC) C 3.0, 2.0, 1.36 or 1.1]. Receiver operating characteristics (ROC) analyses were conducted to determine: (1) degree of selectivity; and (2) the best catecholamine (epinephrine, norepinephrine, and dopamine)-derived index for lateralization of the aldosteronoma-bearing adrenal gland. Among the catecholamine-derived indexes, the epinephrine concentration ratio of adrenal vein to IVC was the most reliable for all four different cut-off values in the evaluation of adrenal vein selectivity. Meanwhile, the ratio of aldosterone to norepinephrine between dominant and non-dominant sides was the most reliable index (right: area under the curve (AUC), 0.965 ± 0.024; 95 % confidence interval (CI), 0.874–0.996; left: AUC, 0.937 ± 0.033; 95 % CI, 0.834–0.985) for lateralization of the aldosteronoma-
Y. Baba (&) S. Hayashi M. Nakajo Department of Radiology, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima-shi, Kagoshima 890-8520, Japan e-mail: [email protected]
bearing gland. Catecholamine concentrations obtained by AVS are useful for not only judging selectivity, but also lateralization of the aldosteronoma-bearing gland. Keywords Primary aldosteronism Aldosteronoma Adrenal vein sampling Catecholamine
Introduction Primary aldosteronism (PA) is the most well-known cause of secondary hypertension, and can result from aldosterone-producing adenoma (aldosteronoma), unilateral adrenal hyperplasia, or idiopathic bilateral adrenal hyperplasia [1, 2]. The first is curable with adrenalectomy, while the latter two are treated medically [3–8]. Distinguishing between these causes is thus important for determining the treatment strategy. Since the prevalence of PA is more frequent than we had expected [1], the number of diagnostic imaging tests for the diagnosis of PA has soared. In addition to various imaging
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