Presentation
Hypertension in a 40-year-old female with primary aldosteronism.
Patient Data
After gaining access through the right femoral vein, the left adrenal venogram was performed using a 5-French cobra catheter and microcatheter. The tip of the microcatheter was positioned at the left adrenal vein, which is located laterally to the division of the left inferior phrenic vein, and blood samples were then obtained sequentially.
Then by using the same 5-French cobra catheter, we inserted and positioned it at the right accessory hepatic vein, a rare anatomical variant. When placing the catheter tip, ensure it reaches the right adrenal vein to avoid hepatic accessory vein interference, which causes contrast medium to fill a hepatic lobule. Further superselective catheterization was performed using a microcatheter to sequentially obtain blood samples from the right adrenal vein.
For adrenal venous sampling, intermittent gentle suction was used to aspirate blood from the adrenal vein and prevent suction-related vessel wall collapse.
During adrenal venous sampling on each side, simultaneous venous sampling from the femoral vein through the sheath was performed as well.
Case Discussion
Adrenal vein sampling is commonly performed in primary aldosteronism (PA), being indicated to identify aldosterone-secreting adenomas and to differentiate adenomas from bilateral adrenal hyperplasia 1. In our case, the aldosterone level on the left side was 30 times higher than on the right side, supporting the diagnosis of aldosterone-secreting adenoma on the left side.
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