The Key Role of CT for Success of Adrenal Venous Sampling Illustrated by a Unique Clinical Case
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We hereby report on a unique case, which underlines the key role of computed tomography (CT) for guiding adrenal vein sampling (AVS) in the subtyping of primary aldosteronism (PA).
A 50-years-old woman presented in 2003 with drug-resistant hypertension, which lasted for more than seven years. Because of hypokalemia (3.3 mEq/l) and a raised aldosterone-to-renin-ratio (ARR) [70.4 (ng/dl)/(ng/ml/h)], which persisted post-captopril [ARR 56.1 (ng/dl)/(ng/ml/h)], she underwent an adrenal CT-scan that showed a 15-mm diameter hypodense lump in the right adrenal gland, and of “slight” ptosis of the right kidney and left kidney in the mid-pelvis. Unfortunately, following the practice ongoing at that time, the adrenal drainage was not assessed. On AVS, selectivity, as defined by an unstimulated selectivity index > 2.0, was not achieved on both sides. Therefore, the test was judged to be useless from the diagnostic standpoint and the patient was discharged on medical treatment with no...
KeywordsSecondary hypertension Hyperaldosteronism
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Conflict of interest
The authors declare that they have no conflict of interest.