Indication and Technical Aspects of Adrenal Blood Sampling

Abstract

Adrenal disorders are relative frequent with regard to the incidence of adrenal tumors and the high portion in causes of secondary hypertension. Morphological changes in the adrenal glands can lead to very different functional disorders that may be clinically overt or hard to diagnose. On the other hand, they can already be functionally relevant when structural changes are too small to be picked up by imaging. Adrenal venous sampling serves to determine the source of hormone excess through the analysis of adrenal blood. In this manuscript, we call attention to the clinical backgrounds, critical points in praxis, technical aspects and developments in the the field of adrenal venous sampling. The consideration of these important points in the clincal setting may make adrenal vein sampling studies sucessful and help to select patients that qualify for adrenalectomy.

Key Points:

• Selective adrenal venous sampling (AVS) currently continues to be the gold standard for localization diagnostics in patients with primary hyperaldosteronism.

• Comprehensive standardization of all preceding examinations and AVS is necessary to ensure high success rates.

• The method is supported by contrast-enhanced imaging for ensuring proper positioning of the catheter in the adrenal veins and the rapid cortisol assay.

• Knowledge of the anatomy and normal variants of the adrenal veins facilitates adrenal venous sampling.

Citation Format:

• Blondin D, Quack I, Haase M et al. Indication and Technical Aspects of Adrenal Blood Sampling. Fortschr Röntgenstr 2015; 187: 19 – 28

Zusammenfassung

Nebennierenerkrankungen sind unter Berücksichtigung der Inzidenzen von Nebennierentumoren und hormonellen Ursachen als prävalenteste sekundäre Hypertonieformen relativ häufig. Morphologische Veränderungen der Nebennieren können zu ganz unterschiedlichen sichtbaren oder kaum messbaren Funktionsstörungen führen. Andererseits können sich Funktionsstörungen klinisch bereits bemerkbar machen, wenn strukturelle Veränderungen der Nebennieren in der Schnittbildgebung noch nicht erfasst werden. Der selektive Nebennierenvenenkatheter dient der Gewinnung adrenalen Blutes, um die Quelle eines Hormonexzesses zu identifizieren. In dieser Arbeit wird auf Hintergründe, Fallstricke, technische Aspekte und Entwicklungen der Nebennierenvenenkatheterdiagnostik eingegangen. Deren Beachtung in der klinischen Praxis kann die Nebennierenvenenblutentnahme zu einer erfolgreichen Prozedur machen und damit helfen, Patienten zu selektieren, die von einer Adrenalektomie profitieren.

Key words

abdomen - adrenal gland - angiography - endocrine disorders

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