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Change in the pattern of adrenal venous sampling over time in patients with primary aldosteronism

Journal of Human Hypertension volume 23, pages 292–294 (2009)Cite this article

We report six patients with primary aldosteronism who had serial adrenal venous sampling. Patients with contralateral suppression of aldosterone to cortisol ratio compared with that in inferior vena cava developed lateralization over time whereas patients without contralateral suppression remained with a bilateral pattern.

Adrenal venous sampling (AVS) distinguishes bilateral from unilateral disease in primary aldosteronism. Lateralization index (LI) is defined by the aldosterone to cortisol (A/C) ratio in the ipsilateral over that of the contralateral adrenal vein. Which cutoff value of LI best predicts unilateral disease is unclear. A previous study showed that an LI more than four gives 95% sensitivity and 100% specificity for unilateral disease.1 However, there is some overlap with LI between 3 and 4.1 This is particularly true when imaging suggests an adrenal mass and LI is equivocal. We retrospectively identified six patients with equivocal AVS results, who had serial AVS. The Institutional Review Board approved the protocol and the waiver of consents. We report the change in the patterns of AVS over time. AVS was performed as previously described.2 Clinical information of all patients is summarized in Table 1 and complete results of AVS are shown in the Supplementary information. All blood pressure (BP) was taken in a seated position.

Table 1 Clinical characteristics of six cases presented
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Authors and Affiliations

  1. Renal Electrolyte and Hypertension Division, Hospital of the University of Pennsylvania, Philadelphia, PA, USA

    M Murashima, R R Townsend & D L Cohen

  2. Division of Interventional Radiology, Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA

    S O Trerotola

  3. Department of Endocrine and Oncologic Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA

    D L Fraker & D Han

Authors
  1. M Murashima
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  2. S O Trerotola
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  3. D L Fraker
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  4. D Han
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  5. R R Townsend
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  6. D L Cohen
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Corresponding author

Correspondence to D L Cohen.

Additional information

Supplementary Information accompanies the paper on the Journal of Human Hypertension website (http://www.nature.com/jhh)

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Murashima, M., Trerotola, S., Fraker, D. et al. Change in the pattern of adrenal venous sampling over time in patients with primary aldosteronism. J Hum Hypertens 23, 292–294 (2009). https://doi.org/10.1038/jhh.2008.108

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