An unexpected finding of apparent bilateral aldosterone suppression after superselective adrenal venous sampling: a case report.
Xiaoxi Pan, Yu Ma, Yuanyuan Kang et al.
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Case in brief
A 40-year-old man with hypertension and refractory hypokalaemia was found to have a right adrenal adenoma. Initial adrenal venous sampling (AVS) showed apparent bilateral aldosterone suppression (ABAS), complicating the diagnosis of primary aldosteronism. A repeat AVS revealed different venographic patterns, confirming right-sided aldosterone excess. Following right adrenalectomy, the patient achieved clinical and biochemical remission, with histological confirmation of an aldosterone-producing adenoma.
What made this case unusual
The case illustrates the diagnostic challenge of ABAS during AVS, where different catheter positions can lead to misleading results regarding aldosterone secretion.
Diagnostic / clinical pearl
Clinicians should be aware that apparent bilateral aldosterone suppression does not rule out unilateral primary aldosteronism, and careful sampling from the main adrenal vein trunk is essential for accurate diagnosis.
Why it matters
This case emphasizes the importance of understanding the potential pitfalls in adrenal venous sampling techniques, which can significantly impact the management of patients with suspected primary aldosteronism.