PDF icon PDF herunterladen
Horm Metab Res 2015; 47(13): 959-966
DOI: 10.1055/s-0035-1565089
Review

Subtype Diagnosis of Primary Aldosteronism: Approach to Different Clinical Scenarios

J. Burrello
1   Division of Internal Medicine and Hypertension, University of Torino, Torino, Italy
,
S. Monticone
1   Division of Internal Medicine and Hypertension, University of Torino, Torino, Italy
,
M. Tetti
1   Division of Internal Medicine and Hypertension, University of Torino, Torino, Italy
,
D. Rossato
2   Division of Radiology, University of Torino, Torino, Italy
,
K. Versace
2   Division of Radiology, University of Torino, Torino, Italy
,
I. Castellano
3   Division of Pathology, Department of Medical Sciences, University of Torino, Torino, Italy
,
T. A. Williams
1   Division of Internal Medicine and Hypertension, University of Torino, Torino, Italy
4   Medizinische Klinik und Poliklinik IV (T.A.W.), Klinikum der Ludwig-Maximilians-Universität München, Munich, Germany
,
F. Veglio
1   Division of Internal Medicine and Hypertension, University of Torino, Torino, Italy
,
P. Mulatero
1   Division of Internal Medicine and Hypertension, University of Torino, Torino, Italy
› Institutsangaben
› Weitere Informationen
Auch verfügbar aufeRef
   Lizenzen und Reprints
Preview

Abstract

Identification and management of patients with primary aldosteronism are of utmost importance because it is a frequent cause of endocrine hypertension, and affected patients display an increase of cardio- and cerebro-vascular events, compared to essential hypertensives. Distinction of primary aldosteronism subtypes is of particular relevance to allocate the patients to the appropriate treatment, represented by mineralocorticoid receptor antagonists for bilateral forms and unilateral adrenalectomy for patients with unilateral aldosterone secretion. Subtype differentiation of confirmed hyperaldosteronism comprises adrenal CT scanning and adrenal venous sampling. In this review, we will discuss different clinical scenarios where execution, interpretation of adrenal vein sampling and subsequent patient management might be challenging, providing the clinician with useful information to help the interpretation of controversial procedures.

Key words

primary aldosteronism - adrenal vein sampling - aldosterone-producing adenoma - bilateral adrenal hyperplasia


Publikationsverlauf

Eingereicht: 15. August 2015

Angenommen: 07. Oktober 2015

Artikel online veröffentlicht:
17. November 2015

Georg Thieme Verlag
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Mosso L, Carvajal C, González A, Barraza A, Avila F, Montero J, Huete A, Gederlini A, Fardella CE. Primary aldosteronism and hypertensive disease. Hypertension 2003; 42: 161-165
    Suche in Google Scholar
  • 2 Calhoun DA, Nishizaka MK, Zaman MA, Thakkar RB, Weissmann P. Hyperaldosteronism among black and white subjects with resistant hypertension. Hypertension 2002; 40: 892-896
    Suche in Google Scholar
  • 3 Hannemann A, Wallaschofski H. Prevalence of primary aldosteronism in patient’s cohorts and in population-based studies – a review of the current literature. Horm Metab Res 2012; 44: 157-162
    Suche in Google Scholar
  • 4 Mulatero P, Monticone S, Bertello C, Viola A, Tizzani D, Iannaccone A, Crudo V, Burrello J, Milan A, Rabbia F, Veglio F. Long-term cardio- and cerebrovascular events in patients with primary aldosteronism. J Clin Endocrinol Metab 2013; 98: 4826-4833
    Suche in Google Scholar
  • 5 Savard S, Amar L, Plouin PF, Steichen O. Cardiovascular complications associated with primary aldosteronism: a controlled cross-sectional study. Hypertension 2013; 62: 331-336
    Suche in Google Scholar
  • 6 Catena C, Colussi G, Nadalini E, Chiuch A, Baroselli S, Lapenna R, Sechi LA. Cardiovascular outcomes in patients with primary aldosteronism after treatment. Arch Intern Med 2008; 168: 80-85
    Suche in Google Scholar
  • 7 Funder JW, Carey RM, Fardella C, Gomez-Sanchez CE, Mantero F, Stowasser M, Young Jr WF, Montori VM. Endocrine Society. Case detection, diagnosis, and treatment of patients with primary aldosteronism: an endocrine society clinical practice guideline. J Clin Endocrinol Metab 2008; 93: 3266-3281
    Suche in Google Scholar
  • 8 Daunt N. Adrenal vein sampling: how to make it quick, easy, and successful. Radiographics 2005; 25: S143-S158
    Suche in Google Scholar
  • 9 Degenhart C, Strube H, Betz MJ, Pallauf A, Bidlingmaier M, Fischer E, Reincke M, Reiser MF, Wirth S. CT mapping of the vertebral level of right adrenal vein. Diagn Interv Radiol 2015; 21: 60-66
    Suche in Google Scholar
  • 10 Kempers MJ, Lenders JW, van Outheusden L, van der Wilt GJ, Schultze Kool LJ, Hermus AR, Deinum J. Systematic review: diagnostic procedures to differentiate unilateral from bilateral adrenal abnormality in primary aldosteronism. Ann Intern Med 2009; 151: 329-337
    Suche in Google Scholar
  • 11 Young WF, Stanson AW. What are the keys to successful adrenal venous sampling (AVS) in patients with primary aldosteronism?. Clin Endocrinol 2009; 70: 14-17
    Suche in Google Scholar
  • 12 Monticone S, Viola A, Rossato D, Veglio F, Reincke M, Gomez-Sanchez C, Mulatero P. Adrenal vein sampling in primary aldosteronism: towards a standardised protocol. Lancet Diabetes Endocrinol 2015; 3: 296-303
    Suche in Google Scholar
  • 13 Miotto D, De Toni R, Pitter G, Seccia TM, Motta R, Vincenzi M, Feltrin G, Rossi GP. Impact of accessory hepatic veins on adrenal vein sampling for identification of surgically curable primary aldosteronism. Hypertension 2009; 54: 885-889
    Suche in Google Scholar
  • 14 Solar M, Ceral J, Krajina A, Ballon M, Malirova E, Brodak M, Cap J. Adrenal Venous Sampling: Where Is the Aldosterone Disappearing to?. Cardiovasc Intervent Radiol 2010; 33: 760-765
    Suche in Google Scholar
  • 15 Satoh F, Morimoto R, Seiji K, Satani N, Ota H, Iwakura Y, Ono Y, Kudo M, Nezu M, Omata K, Tezuka Y, Kawasaki Y, Ishidoya S, Arai Y, Takase K, Nakamura Y, McNamara K, Sasano H, Ito S. Progress in primary aldosteronism: Is there a role for segmental adrenal venous sampling and adrenal sparing surgery in patients with primary aldosteronism?. Eur J Endocrinol 2015; 173: 465-477
    Suche in Google Scholar
  • 16 Doppman JL, Gill Jr JR. Hyperaldosteronism: sampling the adrenal veins. Radiology 1996; 198: 309-312
    Suche in Google Scholar
  • 17 Seccia TM, Miotto D, De Toni R, Pitter G, Mantero F, Pessina AC, Rossi GP. Adrenocorticotropic hormone stimulation during adrenal vein sampling for identifying surgically curable subtypes of primary aldosteronism: comparison of 3 different protocols. Hypertension 2009; 53: 761-766
    Suche in Google Scholar
  • 18 Monticone S, Satoh F, Giacchetti G, Viola A, Morimoto R, Kudo M, Iwakura Y, Ono Y, Turchi F, Paci E, Veglio F, Boscaro M, Rainey W, Ito S, Mulatero P. Effect of adrenocorticotropic hormone stimulation during adrenal vein sampling in primary aldosteronism. Hypertension 2012; 59: 840-846
    Suche in Google Scholar
  • 19 Melby JC, Spark RF, Dale SL, Egdahl RH, Kahn PC. Diagnosis and localization of aldosterone-producing adenomas by adrenal-vein cateterization. N Engl J Med 1967; 277: 1050-1056
    Suche in Google Scholar
  • 20 Stowasser M, Gordon RD, Gunasekera TG, Cowley DC, Ward G, Archibald C, Smithers BM. High rate of detection of primary aldosteronism, including surgically treatable forms, after ‘non-selective’ screening of hypertensive patients. J Hypertens 2003; 21: 2149-2157
    Suche in Google Scholar
  • 21 Young WF, Stanson AW, Thompson GB, Grant CS, Farley DR, van Heerden JA. Role for adrenal venous sampling in primary aldosteronism. Surgery 2004; 136: 1227-1235
    Suche in Google Scholar
  • 22 Mulatero P, Bertello C, Rossato D, Mengozzi G, Milan A, Garrone C, Giraudo G, Passarino G, Garabello D, Verhovez A, Rabbia F, Veglio F. Roles of clinical criteria, computed tomography scan, and adrenal vein sampling in differential diagnosis of primary aldosteronism subtypes. J Clin Endocrinol Metab 2008; 93: 1366-1371
    Suche in Google Scholar
  • 23 Harvey A, Pasieka JL, Kline G, So B. Modification of the protocol for selective adrenal venous sampling results in both a significant increase in the accuracy and necessity of the procedure in the management of patients with primary hyperaldosteronism. Surgery 2012; 152: 643-649
    Suche in Google Scholar
  • 24 Blake MA, Cronin CG, Boland GW. Adrenal imaging. Am J Roentgenol 2010; 194: 1450-1460
    Suche in Google Scholar
  • 25 Zarnegar R, Bloom AI, Lee J, Kerlan Jr RK, Wilson MW, Laberge JM, Gordon RL, Kebebew E, Clark OH, Duh QY. Is adrenal venous sampling necessary in all patients with hyperaldosteronism before adrenalectomy?. J Vasc Interv Radiol 2008; 19: 66-71
    Suche in Google Scholar
  • 26 Letavernier E, Peyrard S, Amar L, Zinzindohoue F, Fiquet B, Plouin PF. Blood pressure outcome of adrenalectomy in patients with primary hyperaldosteronism with or without unilateral adenoma. J Hypertens 2008; 26: 1816-1823
    Suche in Google Scholar
  • 27 Rossi GP, Auchus RJ, Brown M, Lenders JW, Naruse M, Plouin PF, Satoh F, Young Jr WF. An expert consensus statement on use of adrenal vein sampling for the subtyping of primary aldosteronism. Hypertension 2014; 63: 151-160
    Suche in Google Scholar
  • 28 Auchus RJ, Wians Jr FH, Anderson ME, Dolmatch BL, Trimmer CK, Josephs SC, Chan D, Toomay S, Nwariaku FE. What we still do not know about adrenal vein sampling for primary aldosteronism. Horm Metab Res 2010; 42: 411-415
    Suche in Google Scholar
  • 29 Rossi GP, Barisa M, Allolio B, Auchus RJ, Amar L, Cohen D, Degenhart C, Deinum J, Fischer E, Gordon R, Kickuth R, Kline G, Lacroix A, Magill S, Miotto D, Naruse M, Nishikawa T, Omura M, Pimenta E, Plouin PF, Quinkler M, Reincke M, Rossi E, Rump LC, Satoh F, Schultze Kool L, Seccia TM, Stowasser M, Tanabe A, Trerotola S, Vonend O, Widimsky Jr J, Wu KD, Wu VC, Pessina AC. The Adrenal Vein Sampling International Study (AVIS) for identifying the major subtypes of primary aldosteronism. J Clin Endocrinol Metab 2012; 97: 1606-1614
    Suche in Google Scholar
  • 30 Mulatero P, Bertello C, Sukor N, Gordon R, Rossato D, Daunt N, Leggett D, Mengozzi G, Veglio F, Stowasser M. Impact of different diagnostic criteria during adrenal vein sampling on reproducibility of subtype diagnosis in patients with primary aldosteronism. Hypertension 2010; 55: 667-673
    Suche in Google Scholar
  • 31 Mulatero P, Bertello C, Verhovez A, Rossato D, Giraudo G, Mengozzi G, Limerutti G, Avenatti E, Tizzani D, Veglio F. Differential diagnosis of primary aldosteronism subtypes. Curr Hypertens Rep 2009; 11: 217-223
    Suche in Google Scholar
  • 32 Espiner EA, Ross DG, Yandle TG, Richards AM, Hunt PJ. Predicting surgically remedial primary aldosteronism: role of adrenal scanning, posture testing, and adrenal vein sampling. J Clin Endocrinol Metab 2003; 88: 3637-3644
    Suche in Google Scholar
  • 33 Sukor N, Gordon RD, Ku YK, Jones M, Stowasser M. Role of unilateral adrenalectomy in bilateral primary aldosteronism: a 22-year single center experience. J Clin Endocrinol Metab 2009; 94: 2437-2445
    Suche in Google Scholar
  • 34 Doppman JL, Gill Jr JR, Miller DL, Chang R, Gupta R, Friedman TC, Choyke PL, Feuerstein IM, Dwyer AJ, Jicha DL. Distinction between hyperaldosteronism due to bilateral hyperplasia and unilateral aldosteronoma: reliability of CT. Radiology 1992; 184: 677-682
    Suche in Google Scholar
  • 35 Monticone S, Satoh F, Viola A, Fischer E, Vonend O, Bernini G, Lucatello B, Quinkler M, Ronconi V, Morimoto R, Kudo M, Degenhart C, Gao X, Carrara D, Willenberg HS, Rossato D, Mengozzi G, Riester A, Paci E, Iwakura Y, Burrello J, Maccario M, Giacchetti G, Veglio F, Ito S, Reincke M, Mulatero P. Aldosterone suppression on contralateral adrenal during adrenal vein sampling does not predict blood pressure response after adrenalectomy. J Clin Endocrinol Metab 2014; 99: 4158-4166
    Suche in Google Scholar
  • 36 Wolley MJ, Gordon RD, Ahmed AH, Stowasser M. Does contralateral suppression at adrenal venous sampling predict outcome following unilateral adrenalectomy for primary aldosteronism? A retrospective study. J Clin Endocrinol Metab 2015; 100: 1477-1484
    Suche in Google Scholar
  • 37 Lim V, Guo Q, Grant CS, Thompson GB, Richards ML, Farley DR, Young Jr WF. Accuracy of adrenal imaging and adrenal venous sampling in predicting surgical cure of primary aldosteronism. J Clin Endocrinol Metab 2014; 99: 2712-2719
    Suche in Google Scholar
  • 38 Riester A, Fischer E, Degenhart C, Reiser MF, Bidlingmaier M, Beuschlein F, Reincke M, Quinkler M. Age below 40 or a recently proposed clinical prediction score cannot bypass adrenal venous sampling in primary aldosteronism: results of the Else Kröner-Fresenius Hyperaldosteronismus Registry. J Clin Endocrinol Metab 2014; 99: 1035-1039
    Suche in Google Scholar
  • 39 Kloos RT, Gross MD, Francis IR, Korobkin M, Shapiro B. Incidentally discovered adrenal masses. Endocr Rev 1995; 16: 460-484
    Suche in Google Scholar
  • 40 Nishikawa T, Omura M, Saito J, Matsuzawa Y. Primary aldosteronism: comparison between guidelines of the Japanese and the US Endocrine Society. Exp Rev Endocrinol Metab 2012; 7: 637-645
    Suche in Google Scholar
  • 41 Omura M, Saito J, Matsuzawa Y, Nishikawa T. Supper-selective ACTH-stimulated adrenal vein sampling is necessary for detecting precisely functional state of various lesions in unilateral and bilateral adrenal disorders, inducing primary aldosteronism with subclinical Cushing’s syndrome. Endocr J 2011; 58: 919-920
    Suche in Google Scholar
  • 42 Satani N, Ota H, Seiji K, Morimoto R, Kudo M, Iwakura Y, Ono Y, Nezu M, Omata K, Ito S, Satoh F, Takase K. Intra-adrenal Aldosterone Secretion: Segmental Adrenal Venous Sampling for Localization. Radiology 2015; 6: 142159 [Epub ahead of print]
    Suche in Google Scholar
  • 43 Wolley M, Gordon RD, Pimenta E, Daunt N, Slater GJ, Ahmed AH, Stowasser M. Repeating adrenal vein sampling when neither aldosterone/cortisol ratio exceeds peripheral yields a high incidence of aldosterone-producing adenoma. J Hypertens 2013; 31: 2005-2009
    Suche in Google Scholar
  • 44 Monticone S, Castellano I, Versace K, Lucatello B, Veglio F, Gomez-Sanchez CE, Williams TA, Mulatero P. Immunohistochemical, genetic and clinical characterization of sporadic aldosterone-producing adenomas. Mol Cell Endocrinol 2015; 411: 146-154
    Suche in Google Scholar
  • 45 Fu B, Zhang X, Wang GX, Lang B, Ma X, Li HZ, Wang BJ, Shi TP, Ai X, Zhou HX, Zheng T. Long-term results of a prospective, randomized trial comparing retroperitoneoscopic partial versus total adrenalectomy for aldosterone producing adenoma. J Urol 2011; 185: 1578-1582
    Suche in Google Scholar
  • 46 Walz MK, Gwosdz R, Levin SL, Alesina PF, Suttorp AC, Metz KA, Wenger FA, Petersenn S, Mann K, Schmid KW. Retroperitoneoscopic adrenalectomy in Conn’s syndrome caused by adrenal adenomas or nodular hyperplasia. World J Surg 2008; 32: 847-853
    Suche in Google Scholar
  • 47 Ishidoya S, Ito A, Sakai K, Satoh M, Chiba Y, Sato F, Arai Y. Laparoscopic partial versus total adrenalectomy for aldosterone producing adenoma. J Urol 2005; 174: 40-43
    Suche in Google Scholar
  • 48 Mengozzi G, Rossato D, Bertello C, Garrone C, Milan A, Pagni R, Veglio F, Mulatero P. Rapid cortisol assay during adrenal vein sampling in patients with primary aldosteronism. Clin Chem 2007; 53: 1968-1971
    Suche in Google Scholar
  • 49 Betz MJ, Degenhart C, Fischer E, Pallauf A, Brand V, Linsenmaier U, Beuschlein F, Bidlingmaier M, Reincke M. Adrenal vein sampling using rapid cortisol assays in primary aldosteronism is useful in centers with low success rates. Eur J Endocrinol 2011; 165: 301-306
    Suche in Google Scholar
  • 50 Auchus RJ, Michaelis C, Wians Jr FH, Dolmatch BL, Josephs SC, Trimmer CK, Anderson ME, Nwariaku FE. Rapid cortisol assays improve the success rate of adrenal vein sampling for primary aldosteronism. Ann Surg 2009; 249: 318-321
    Suche in Google Scholar
  • 51 Rossi GP, Sacchetto A, Chiesura-Corona M, De Toni R, Gallina M, Feltrin GP, Pessina AC. Identification of the etiology of primary aldosteronism with adrenal vein sampling in patients with equivocal computed tomography and magnetic resonance findings: results in 104 consecutive cases. J Clin Endocrinol Metab 2001; 86: 1083-1090
    Suche in Google Scholar
  • 52 Ceral J, Solar M, Krajina A, Ballon M, Suba P, Cap J. Adrenal venous sampling in primary aldosteronism: a low dilution of adrenal venous blood is crucial for a correct interpretation of the results. Eur J Endocrinol 2010; 162: 101-107
    Suche in Google Scholar
  • 53 Azizan EA, Poulsen H, Tuluc P, Zhou J, Clausen MV, Lieb A, Maniero C, Garg S, Bochukova EG, Zhao W, Shaikh LH, Brighton CA, Teo AE, Davenport AP, Dekkers T, Tops B, Küsters B, Ceral J, Yeo GS, Neogi SG, McFarlane I, Rosenfeld N, Marass F, Hadfield J, Margas W, Chaggar K, Solar M, Deinum J, Dolphin AC, Farooqi IS, Striessnig J, Nissen P, Brown MJ. Somatic mutations in ATP1A1 and CACNA1D underlie a common subtype of adrenal hypertension. Nat Genet 2013; 45: 1055-1060
    Suche in Google Scholar
  • 54 Fallo F, Bertello C, Tizzani D, Fassina A, Boulkroun S, Sonino N, Monticone S, Viola A, Veglio F, Mulatero P. Concurrent primary aldosteronism and subclinical cortisol hypersecretion: a prospective study. J Hypertens 2011; 29: 1773-1777
    Suche in Google Scholar
  • 55 Hiraishi K, Yoshimoto T, Tsuchiya K, Minami I, Doi M, Izumiyama H, Sasano H, Hirata Y. Clinico-pathological features of primary aldosteronism associated with subclinical Cushing’s syndrome. Endocr J 2011; 58: 543-551
    Suche in Google Scholar
  • 56 Späth M, Korovkin S, Antke C, Anlauf M, Willenberg HS. Aldosterone- and cortisol-co-secreting adrenal tumors: the lost subtype of primary aldosteronism. Eur J Endocrinol 2011; 164: 447-455
    Suche in Google Scholar
  • 57 Dekkers T, Deinum J, Schultzekool LJ, Blondin D, Vonend O, Hermus AR, Peitzsch M, Rump LC, Antoch G, Sweep FC, Bornstein SR, Lenders JW, Willenberg HS, Eisenhofer G. Plasma metanephrine for assessing the selectivity of adrenal venous sampling. Hypertension 2013; 62: 1152-1157
    Suche in Google Scholar
  • 58 Seccia TM, Miotto D, De Toni R, Maniero C, Vincenzi M, Motta R, Pessina AC, Rossi GP. Chromogranin a measurement for assessing the selectivity of adrenal venous sampling in primary aldosteronism. J Clin Endocrinol Metab 2011; 96: 825-829
    Suche in Google Scholar