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CC BY-NC-ND 4.0 · Journal of Clinical Interventional Radiology ISVIR 2017; 01(02): 071-076
DOI: 10.1055/s-0037-1602769
Original Article
Indian Society of Vascular and Interventional Radiology

Combined Efficacy of Adrenal Vein Sampling and Imaging Findings in Predicting Clinical Outcomes Following Unilateral Adrenalectomy for Primary Aldosteronism

Rajiv N. Srinivasa
1   Division of Interventional Radiology, Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas, United States
,
Matthew E. Anderson
1   Division of Interventional Radiology, Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas, United States
,
Alan P. Dackiw
2   Division of Endocrine Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, United States
,
Anil K. Pillai
1   Division of Interventional Radiology, Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas, United States
,
Clayton K. Trimmer
1   Division of Interventional Radiology, Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas, United States
,
Sanjeeva P. Kalva
1   Division of Interventional Radiology, Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas, United States
,
Stephen P. Reis
3   Department of Radiology, Columbia University Medical Center, New York, New York, United States
› Author Affiliations
Further Information

Publication History

Publication Date:
28 July 2017 (online)

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Abstract

The objective of this study was to investigate the combined efficacy of adrenal vein sampling (AVS) and imaging findings in predicting successful clinical outcomes following unilateral adrenalectomy for primary aldosteronism (PA). A retrospective chart review of 137 patients who underwent AVS between 2009 and 2014 at two hospitals in a single academic institution was performed. Preprocedure demographic, imaging, medication, and laboratory values were reviewed. In general, patients were considered for adrenalectomy when lateralization was suggested on AVS. Clinical outcomes such as improved blood pressure control and preserved renal function after adrenalectomy were correlated with preprocedure variables. AVS was technically successful in 120 out of 137 patients. Lateralization was seen in 64 patients and 48 out of 64 patients underwent adrenalectomy. Out of 48, 43 patients had an adrenal nodule on preoperative imaging, while 5 did not. 28 patients showed improvement in blood pressure after adrenalectomy, all of which had a nodule on imaging. Of the 28 patients, 22 also showed preservation of renal function. None of the remaining 5 (out of 48) patients who demonstrated lateralization on AVS and had no nodule on imaging showed clinical improvement following adrenalectomy. The presence of an adrenal nodule on preoperative imaging was also associated with improved blood pressure control (p = 0.022) and preserved renal function (p = 0.048) following adrenalectomy. Improved blood pressure control and preserved renal function in patients with PA who underwent adrenalectomy following lateralization on AVS are associated with the identification of an adrenal nodule on preoperative imaging.

Keywords

adrenal vein sampling - primary aldosteronism - adrenalectomy
 

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