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Review

Subtype Diagnosis of Primary Aldosteronism: Is Adrenal Vein Sampling Always Necessary?

by
Fabrizio Buffolo
1,†,
Silvia Monticone
1,†,
Tracy A. Williams
1,2,
Denis Rossato
3,
Jacopo Burrello
1,
Martina Tetti
1,
Franco Veglio
1 and
Paolo Mulatero
1,*
1
Division of Internal Medicine and Hypertension Unit, Department of Medical Sciences, University of Torino, Via Genova 3, 10126 Torino, Italy
2
Medizinische Klinik und Poliklinik IV, Klinikum der Ludwig-Maximilians-Universität München, 81377 Munich, Germany
3
Service of Radiology, University of Torino, 10126 Torino, Italy
*
Author to whom correspondence should be addressed.
†
These authors contributed equally to this work.
Int. J. Mol. Sci. 2017, 18(4), 848; https://doi.org/10.3390/ijms18040848
Submission received: 16 March 2017 / Revised: 11 April 2017 / Accepted: 12 April 2017 / Published: 17 April 2017
(This article belongs to the Special Issue Selected Papers from the Renin–Angiotensin–Aldosterone System (RAAS)2016: Official Satellite of ISH2016, from September 23 to 24 in Tokyo, Japan)
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Abstract

Aldosterone producing adenoma and bilateral adrenal hyperplasia are the two most common subtypes of primary aldosteronism (PA) that require targeted and distinct therapeutic approaches: unilateral adrenalectomy or lifelong medical therapy with mineralocorticoid receptor antagonists. According to the 2016 Endocrine Society Guideline, adrenal venous sampling (AVS) is the gold standard test to distinguish between unilateral and bilateral aldosterone overproduction and therefore, to safely refer patients with PA to surgery. Despite significant advances in the optimization of the AVS procedure and the interpretation of hormonal data, a standardized protocol across centers is still lacking. Alternative methods are sought to either localize an aldosterone producing adenoma or to predict the presence of unilateral disease and thereby substantially reduce the number of patients with PA who proceed to AVS. In this review, we summarize the recent advances in subtyping PA for the diagnosis of unilateral and bilateral disease. We focus on the developments in the AVS procedure, the interpretation criteria, and comparisons of the performance of AVS with the alternative methods that are currently available.
Keywords: aldosterone; primary aldosteronism; adrenal vein sampling; cosyntropin stimulation; aldosterone producing adenoma; bilateral adrenal hyperplasia aldosterone; primary aldosteronism; adrenal vein sampling; cosyntropin stimulation; aldosterone producing adenoma; bilateral adrenal hyperplasia
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MDPI and ACS Style

Buffolo, F.; Monticone, S.; Williams, T.A.; Rossato, D.; Burrello, J.; Tetti, M.; Veglio, F.; Mulatero, P. Subtype Diagnosis of Primary Aldosteronism: Is Adrenal Vein Sampling Always Necessary? Int. J. Mol. Sci. 2017, 18, 848. https://doi.org/10.3390/ijms18040848

AMA Style

Buffolo F, Monticone S, Williams TA, Rossato D, Burrello J, Tetti M, Veglio F, Mulatero P. Subtype Diagnosis of Primary Aldosteronism: Is Adrenal Vein Sampling Always Necessary? International Journal of Molecular Sciences. 2017; 18(4):848. https://doi.org/10.3390/ijms18040848

Chicago/Turabian Style

Buffolo, Fabrizio, Silvia Monticone, Tracy A. Williams, Denis Rossato, Jacopo Burrello, Martina Tetti, Franco Veglio, and Paolo Mulatero. 2017. "Subtype Diagnosis of Primary Aldosteronism: Is Adrenal Vein Sampling Always Necessary?" International Journal of Molecular Sciences 18, no. 4: 848. https://doi.org/10.3390/ijms18040848

APA Style

Buffolo, F., Monticone, S., Williams, T. A., Rossato, D., Burrello, J., Tetti, M., Veglio, F., & Mulatero, P. (2017). Subtype Diagnosis of Primary Aldosteronism: Is Adrenal Vein Sampling Always Necessary? International Journal of Molecular Sciences, 18(4), 848. https://doi.org/10.3390/ijms18040848

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