Utility of Repeat Sampling in Bilateral Aldosterone Suppression During Adrenal Vein Sampling for Primary Aldosteronism

  • JCEM Case Rep. 2024 Apr 10;2(4):luae051. doi: 10.1210/jcemcr/luae051.
Bella Halim  1  2 ,  Eric X Z Yong  3  4 ,  Matthew Egan  5 ,  Richard J MacIsaac  1  2 ,  David O'Neal  1  2 ,  Nirupa Sachithanandan  1  2
Affiliations
  • 1. Department of Endocrinology & Diabetes, St Vincent's Hospital Melbourne, Fitzroy, Victoria 3065, Australia.
  • 2. Department of Medicine, The University of Melbourne, Fitzroy, Victoria 3065, Australia.
  • 3. Department of Radiology, St Vincent's Hospital Melbourne, Fitzroy, Victoria 3065, Australia.
  • 4. Department of Cancer Imaging, Peter MacCallum Cancer Centre, Parkville, Victoria 3000, Australia.
  • 5. Department of Pathology, St Vincent's Hospital Melbourne, Fitzroy, Victoria 3065, Australia.
PMID: 38601064 DOI: 10.1210/jcemcr/luae051
Abstract

Primary aldosteronism (PA) is the most common form of secondary Hypertension. Accurate subtyping of PA is essential to identify unilateral disease, as adrenalectomy improves outcomes. Subtyping PA requires adrenal vein sampling (AVS), which is technically challenging and results from AVS may not always be conclusive. We present a case of a 37-year-old man with PA whose AVS studies were inconclusive due to apparent bilateral aldosterone suppression (ABAS). As a result, our patient was misdiagnosed as having bilateral PA and medically managed until a repeat AVS showed lateralization to the right adrenal gland. ABAS is an underrecognized phenomenon that may confound the subtyping of PA. We recommend repeating AVS in such cases and discuss strategies to minimize ABAS.

Keywords
adrenal vein sampling; apparent bilateral aldosterone suppression; double-down AVS; primary aldosteronism.