dominant
adrenal vein vs nondominant
adrenal vein).
Most investigators concur that a lateralization index of 4 or higher during cosyntropin stimulation ([greater than or equal to] 2 for unstimulated
adrenal vein sampling) is indicative of unilateral aldosterone production and favors the diagnosis of aldosterone-producing adenoma, whereas a lateralization index lower than 4 is more suggestive of bilateral aldosterone production involving bilateral adrenal hyperplasia.
Apart from the adrenal cortex, supplied only by small caliber blood vessels, the adrenal medulla is endowed with large blood vessels (especially the
adrenal vein, with a special distribution of muscular fibers, in order to ensure a prompt propulsion of the blood in stressful conditions).
If there is an adrenal mass,
adrenal vein sampling (AVS) should be tested.
The entire specimen was removed en bloc (Figure 2) consisting of diaphragm, right adrenal metastasis measuring 6 cm x 4 cm x 3 cm, a scant amount of normal adrenal tissue, the small patch of IVC and the right
adrenal vein which was completely encased by tumor.
Following ACTH stimulation the mean
adrenal vein vitamin C level increased approximately four fold, and then subsequently returned to near pre-stimulation levels approximately 15 minutes thereafter.
It is estimated that only four to six people are diagnosed with this type of tumour in Scotland each year and in Allison's case it had already started to spread to her
adrenal vein.
Complications occurred in five patients (5%) including one postoperative ileus, one superficial wound infection, one postoperative incisional neuropathy, one bleeding from the left renal artery, and one bleeding from the
adrenal vein.
After
adrenal vein ligation precipitous hypotension occurred with blood pressure of 86/56mm Hg which was managed with bolus of intravenous fluid and noradrenaline infusion.
Intraoperatively, there were no surgical complications; however, given the size of the mass, it was difficult to isolate the
adrenal vein early and subsequent manipulation of the mass resulted in blood pressure fluctuations, despite preoperative blockade.
Primary aldosteronism- part I: prevalence, screening, and selection of cases for
adrenal vein sampling.
According to these criteria, the success rate for cannulation of the right
adrenal vein at Greenslopes Hospital has remained =90% since 1999 (2).
