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Effect of Adrenal Vein Sampling on Surgical Outcome

Fiemu E. Nwariaku, MD; Barbra S. Miller, MD; Richard Auchus, MD, PhD; Shelby Holt, MD; Lori Watumull, MD; Bart Dolmatch, MD; Shawna Nesbitt, MD; Wanpen Vongpatanasin, MD; Ronald Victor, MD; Frank Wians, PhD; Edward Livingston, MD; William H. Snyder III, MD

Arch Surg. 2006;141:497-503.

Hypothesis  Adrenal vein sampling is superior to computed tomography for subtype differentiation of primary hyperaldosteronism.

Design  Retrospective review.

Setting  University medical center.

Patients  Forty-eight patients (32 men and 16 women) with biochemically confirmed primary hyperaldosteronism.

Main Outcome Measures  We compared demographic factors, results of biochemical and imaging studies (computed tomography and adrenal vein sampling), therapy, and patient outcomes.

Results  Mean ± SEM adrenal nodule size was 1.54 ± 0.2 cm. Adrenal vein sampling was performed in 41 (85%) of 48 patients, and it was successful in 39 (95%) of those 41 patients. Concordance between computed tomography and adrenal vein sampling was observed in 22 (54%) of the 41 patients. Thirty-two patients underwent successful laparoscopic adrenalectomy. There was 1 complication and no deaths. All 32 patients were cured of hypokalemia.

Conclusion  Adrenal vein sampling is superior to image-based techniques for subtype differentiation of primary hyperaldosteronism.

Author Affiliations: Departments of Surgery (Drs Nwariaku, Miller, Holt, Livingston, and Snyder), Medicine (Drs Auchus, Nesbitt, Vongpatanasin, and Victor), Radiology (Drs Watumull and Dolmatch), and Pathology (Dr Wians), University of Texas Southwestern Medical Center, Dallas.

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