ArticleEuropean journal of endocrinology2025
Discordance between adrenal vein sampling and imaging: the role of unilateral cortisol excess.
Article in European journal of endocrinology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers, 1 of them a synthesis that pooled it.
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Who cites it
4 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Agreement Between Molecular Imaging and Adrenal Vein Sampling for Localization in Primary Aldosteronism: A Systematic Review.Journal of the American Heart Association · 2026Pooled it
- Primary aldosteronism.Nature reviews. Disease primers · 2026Review
- Impact of autonomous cortisol secretion on adrenal venous sampling with and without ACTH stimulation in patients with primary aldosteronism.Endocrine journal · 2026Article
- False-positive results of adrenal venous sampling due to mild autonomous cortisol secretion in a patient with primary aldosteronism: a case report with review of literature.Endocrine journal · 2026Review
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Authors and funding
10 authors.
Funding
Abstract
objectiveAdrenal vein sampling (AVS) is considered the gold-standard for identifying unilateral primary aldosteronism (PA), but is sensitive to any asymmetry in cortisol production. Subclinical autonomous cortisol production likely contributes to discordance between cross-sectional imaging and AVS. DESIGN AND
methodsRetrospective chart review was performed of patients in Calgary, Alberta who (1) had a diagnosis of PA with clear adrenal mass, (2) had discordant AVS and cross-sectional imaging, and (3) underwent dexamethasone-suppressed NP59-iodocholesterol adrenal scintigraphy (n = 25). Postoperative biochemical and clinical outcomes were evaluated. Surgical pathology was analyzed with immunohistochemical staining for CYP11B1 and CYP11B2.
resultsNP59 scanning demonstrated autonomous steroidogenesis from the same side as the computed tomography (CT)-identified lesion, despite discordant AVS results, in 19/25 cases. Out of the 16 patients who underwent adrenalectomy (guided by NP59), 11 cases had a final diagnosis of cortisol-producing adenoma with bilateral PA, while the final diagnosis in the remaining 5 cases was cortisol-producing adenoma with unilateral PA (defined by a complete biochemical response). All cases preoperatively had low/suppressed adrenocorticotropin hormone that rose postadrenalectomy, in keeping with the resolution of cortisol autonomy. Adrenal vein sampling incorrectly diagnosed the subtype of PA or falsely localized the side of aldosterone excess in 10/16 cases.
conclusionsDiscordant CT and AVS results in patients with PA and obvious adrenal mass are often explained by subclinical asymmetric cortisol excess. Clinicians should be aware of the limitations of AVS in the presence of subtle autonomous cortisol secretion and must be able to counsel patients regarding the possible outcomes from surgery when discordant lateralization is present.
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