Background: Primary aldosteronism is the most common cause of secondary hypertension. In patients with primary aldosteronism, CT imaging and adrenal vein sampling (AVS), a minimally invasive procedure, are common workups to determine lateralization of hormone production prior to adrenalectomy. This is an important distinction as the management varies based upon a unilateral versus bilateral nature as well as a realization that imaging alone may lead to inappropriate adrenalectomy. 

Case: Patient is a 66-year-old male diagnosed with primary aldosteronism after presenting with poorly controlled hypertension and persistent hypokalemia despite being on five antihypertensive medications and potassium supplementation. CT abdomen showed a 2 cm left sided adrenal nodule. He was referred to interventional radiology for AVS. Cosyntropin infusion was used to stimulate hormone production prior to sampling. Venous samples were collected from the left adrenal vein, right adrenal vein and IVC. Samples at each site were tested for cortisol and aldosterone levels. Lateralization index of right adrenal vein samples was 5.5, indicating right sided hypersecretion, discordant from the CT findings of a left sided nodule that was presumed to be the source of aldosteronism. Based on the AVS results, the patient instead underwent right sided adrenalectomy. Since surgery, his potassium has normalized without the need for supplementation and he is weaning off antihypertensive medications. 

Conclusion: Discrepancies in imaging and adrenal vein sampling, as described in this case, are common, therefore, patients with primary aldosteronism should undergo AVS to determine lateralization to guide further surgical or medical treatments. While CT has benefits, such as allowing assessment of nodules or masses that may be present as well as visualization of vascular anatomy, surgical intervention should not solely rely on imaging findings. 


Discordance Between Imaging and Adrenal Vein Sampling in Patient with Primary Aldosteronism


 Radiology / Nuclear Medicine / Radiation Oncology

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Discordance Between Imaging and Adrenal Vein Sampling in Patient with Primary Aldosteronism

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