Clinical Management and Outcomes of Adrenal Hemorrhage Following Adrenal Vein Sampling in Primary Aldosteronism

Monticone, Silvia, Satoh, Fumitoshi, Dietz, Anna S., Goupil, Remi, Lang, Katharina, Pizzolo, Francesca, Gordon, Richard D., Morimoto, Ryo, Reincke, Martin, Stowasser, Michael and Mulatero, Paolo (2015) Clinical Management and Outcomes of Adrenal Hemorrhage Following Adrenal Vein Sampling in Primary Aldosteronism. Hypertension, 67 1: 146-152. doi:10.1161/HYPERTENSIONAHA.115.06305

Author Monticone, Silvia
Satoh, Fumitoshi
Dietz, Anna S.
Goupil, Remi
Lang, Katharina
Pizzolo, Francesca
Gordon, Richard D.
Morimoto, Ryo
Reincke, Martin
Stowasser, Michael
Mulatero, Paolo
Title Clinical Management and Outcomes of Adrenal Hemorrhage Following Adrenal Vein Sampling in Primary Aldosteronism
Journal name Hypertension   Check publisher's open access policy
ISSN 1524-4563
Publication date 2015-11-16
Year available 2015
Sub-type Article (original research)
DOI 10.1161/HYPERTENSIONAHA.115.06305
Open Access Status Not yet assessed
Volume 67
Issue 1
Start page 146
End page 152
Total pages 11
Place of publication Philadelphia, PA, United States
Publisher Lippincott Williams and Wilkins
Language eng
Formatted abstract
Aldosterone-producing adenoma and bilateral adrenal hyperplasia account for >90% of all primary aldosteronism cases. Distinguishing between bilateral and unilateral disease is of fundamental importance because it allows targeted therapy. Adrenal vein sampling (AVS) is the only reliable means to preoperatively differentiate between unilateral and bilateral subtypes. A rare but serious complication of AVS is an adrenal hemorrhage (AH). We retrospectively examined in detail 24 cases of AH during AVS in 6 different referral hypertension centers. AH more often affected the right adrenal (n=18) than the left (n=5, P<0.001); 1 bilateral. Median duration of experience of the radiologist in AVS at the time of AH was 5.0 years (0.6–7.8) and AH occurred with both highly experienced (>10 years) and less experienced radiologists. Of 9 patients who suffered AH in the gland contralateral to an aldosterone-producing adenoma and who underwent complete (n=6) or partial (n=3) unilateral adrenalectomy, only one required long-term corticosteroid replacement for adrenal insufficiency. No reduction in blood pressure or biochemical resolution of primary aldosteronism occurred in any of those patients who experienced AH in the gland ipsilateral to an aldosterone-producing adenoma (n=6) or who had bilateral adrenal hyperplasia (n=9). No patient required invasive treatments to control bleeding or blood transfusion. In conclusion, AH usually has a positive outcome causing either no or minor effects on adrenal function, and AVS should remain the best approach to primary aldosteronism subtype differentiation.
Keyword Adrenal hemorrhage
Adrenal vein sampling
Aldosterone-producing adenoma
Bilateral Adrenal Hyperplasia
Primary aldosteronism
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2016 Collection
School of Medicine Publications
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