Article thumbnail

Adrenal Venous Sampling: Where Is the Aldosterone Disappearing to?

By Miroslav Solar, Jiri Ceral, Antonin Krajina, Marek Ballon, Eva Malirova, Milos Brodak and Jan Cap


Adrenal venous sampling (AVS) is generally considered to be the gold standard in distinguishing unilateral and bilateral aldosterone hypersecretion in primary hyperaldosteronism. However, during AVS, we noticed a considerable variability in aldosterone concentrations among samples thought to have come from the right adrenal glands. Some aldosterone concentrations in these samples were even lower than in samples from the inferior vena cava. We hypothesized that the samples with low aldosterone levels were unintentionally taken not from the right adrenal gland, but from hepatic veins. Therefore, we sought to analyze the impact of unintentional cannulation of hepatic veins on AVS. Thirty consecutive patients referred for AVS were enrolled. Hepatic vein sampling was implemented in our standardized AVS protocol. The data were collected and analyzed prospectively. AVS was successful in 27 patients (90%), and hepatic vein cannulation was successful in all procedures performed. Cortisol concentrations were not significantly different between the hepatic vein and inferior vena cava samples, but aldosterone concentrations from hepatic venous blood (median, 17 pmol/l; range, 40–860 pmol/l) were markedly lower than in samples from the inferior vena cava (median, 860 pmol/l; range, 460–4510 pmol/l). The observed difference was statistically significant (P < 0.001). Aldosterone concentrations in the hepatic veins are significantly lower than in venous blood taken from the inferior vena cava. This finding is important for AVS because hepatic veins can easily be mistaken for adrenal veins as a result of their close anatomic proximity

Topics: Clinical Investigation
Publisher: Springer-Verlag
OAI identifier:
Provided by: PubMed Central

To submit an update or takedown request for this paper, please submit an Update/Correction/Removal Request.

Suggested articles


  1. DoppmanJL,GillJRJr,MillerDLetal(1992)Distinctionbetween hyperaldosteronism due to bilateral hyperplasia and unilateral aldosteronoma: reliability of CT.
  2. (2001). Identifi-cation 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.
  3. Mulatero P,StowasserM,Loh KC etal (2004)Increased diagnosis of primary aldosteronism, including surgically correctable forms, in centers from five continents.
  4. (2004). Primary aldosteronism—careful investigation is essential and rewarding.
  5. (1979). Primary aldosteronism: diagnosis, localization, and treatment.
  6. (2007). Primary aldosteronism: renaissance of a syndrome. Clin Endocrinol (Oxf)
  7. (2003). Primary aldosteronism.
  8. (2004). Role for adrenal venous sampling in primary aldosteronism.
  9. (2008). Roles of clinical criteria, computed tomography scan, and adrenal vein sampling in differential diagnosis of primary aldosteronism subtypes.
  10. (2009). What are the keys to successful adrenal venous sampling (AVS) in patients with primary aldosteronism? Clin Endocrinol (Oxf)