Faculty Collaboration Database

Wide Variability in Catecholamine Levels From Adrenal Venous Sampling in Primary Aldosteronism. J Surg Res 2022 Sep;277:1-6

Date

04/23/2022

Pubmed ID

35453052

DOI

10.1016/j.jss.2022.03.016

Scopus ID

2-s2.0-85128261569 (requires institutional sign-in at Scopus site)   2 Citations

Abstract

INTRODUCTION: While adrenal venous sampling (AVS) differentiates between the unilateral and bilateral disease in patients with primary aldosteronism (PA), it is unknown if AVS can determine laterality of pheochromocytoma in patients with bilateral adrenal masses. This study analyzes adrenal vein (AV) epinephrine and norepinephrine levels in nonpheochromocytoma patients to determine the "normal" range.

MATERIALS AND METHODS: We reviewed patients who underwent AVS for PA between 2009 and 2019 at a single institution; pheochromocytoma was excluded. Aldosterone, cortisol, epinephrine, and norepinephrine levels were obtained from the inferior vena cava (IVC), left adrenal vein (LAV), and right adrenal vein (RAV). Successful AV cannulation was defined by an AV/IVC cortisol ratio of ≥3:1 or an AV epinephrine level ≥364 pg/mL. Plasma measurements (pg/mL) are median values with interquartile ranges; normal ranges for epinephrine and norepinephrine are 10-200 pg/mL and 80-520 pg/mL, respectively.

RESULTS: AVS was performed in 172 patients in 405 AVs (173 LAV and 232 RAV). Median epinephrine levels were IVC = 19 (14 and 34), LAV = 3811 (1870 and 6915), and RAV = 2897 (1500 and 5288). Median norepinephrine levels were IVC = 325 (186 and 479), LAV = 1450 (896 and 2050), and RAV = 786 (436 and 1582). There was a difference between LAV and RAV epinephrine levels (P = 0.024) and between LAV and RAV norepinephrine (P = 0.002) levels.

CONCLUSIONS: This extensive experience with AVS demonstrated a wide range of "normal" AV catecholamine levels in patients without pheochromocytoma, which suggests that the utility of AVS to determine disease laterality in patients with pheochromocytoma and bilateral adrenal nodules is likely to be limited.

Author List

DeLozier OM, Dream S, Findling JW, Rilling W, Kidambi S, Magill SB, Evans DB, Wang TS

Authors

Sophie Y. Dream MD Assistant Professor in the Surgery department at Medical College of Wisconsin
Douglas B. Evans MD Chair, Professor in the Surgery department at Medical College of Wisconsin
James W. Findling MD Professor in the Medicine department at Medical College of Wisconsin
Srividya Kidambi MD Sr Medical Director, Chief, Professor in the Medicine department at Medical College of Wisconsin
Steven B. Magill MD, PhD Staff Physician in the Medicine department at Medical College of Wisconsin
William S. Rilling MD, FSIR Vice Chair, Professor in the Radiology department at Medical College of Wisconsin
Tracy S. Wang MD, MPH Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adrenal Gland Neoplasms
Adrenal Glands
Epinephrine
Humans
Hydrocortisone
Hyperaldosteronism
Norepinephrine
Pheochromocytoma
Retrospective Studies