Table 2.
Imaging and adrenal vein sampling details according to indication for repeat sampling
| Patient | Imaging results | Reason for repeat AVS | AVS 1 result | Time interval, mo | AVS 2 result | Final outcome, management details |
|---|---|---|---|---|---|---|
| 1 | No lesion | Failed R cath | bRSI 1.0 sRSI 1.5 |
4 | bRSI 1.8 sRSI 35.7 |
Success; lateralized R; normal BP on MRA |
| 2 | 14 mm L | Failed R cath | bRSI 1.0 sRSI 1.2 |
3 | bRSI 0.9 sRSI 1.0 |
Failed AVS; L ADx based on CT |
| 3 | 15 mm L | Contralateral LI | bLI 6.0 (R) | 7 | bLI 5.1 (R) | Same results |
| 4 | 16 mm L | Contralateral LI | bLI 15.3 (R) | 2 | bLI 4.2 (R) | Same resultsa NP-59 scan shows hyperfunctioning L adrenal mass; surgery to remove tumor was curative |
| 5 | 9 mm R | Failed L cath | bLSI 1.1 sLSI 2.0 |
7 | bLSI 13.2 sLSI 86.2 |
Success; lateralized R |
| 6 | 9 mm L | Contralateral LI | bLI 6.0 (R) sLI 3.7 (R) |
5 | bLI 1.6 (R) sLI 9.1 (R) |
Same results |
| 7 | 28 mm R | Contralateral LI | bLI 3.1 (L) sLI 4.1 (L) |
2 | bLI 2.6 (L) sLI 3.7 (L) |
Same resultsa Left ADx but persistent high BP and high ARR |
| 8 | 11 mm L | Contralateral LI | bLI 4.6 (R) sLI 14.2 (R) |
2 | bLI 14.4 (R) sLI 9.2 (R) |
Same results—R ADx shows 15-mm R mass not seen on CT; normal ARR and clinical cure |
| 9 | 29 mm L | Failed R cath | bRSI 1.1 sRSI 1.1 |
2 | bRSI 4.7 sRSI 52 |
Success but contralateral LI; MRA therapya |
| 10 | No lesion | Lateralization with no adrenal mass | bLI 34.7 (R) sLI 27.6 (R) |
43 | bLI 114 (R) sLI 60.8 (R) |
Same results—Lateralized R |
| 11 | No lesion | Failed L cath | bLSI 1.0 sLSI 1.8 |
4 | bLSI 1.6 sLSI 27.7 |
Success but no lateralization: MRA therapy |
| 12 | 8 mm L | Contralateral LI | sLI 4.7 (R) | 7 | bLI 18.6 (R) sLI 13.1 (R) |
Same results |
| 13 | 17 mm R | Contralateral LI | bLI 7.2 (L) | 4 | bLI 89.3 (R) sLI 4.1 (R) |
Same resultsa, left ADx but persistent high BP and ARR |
| 14 | No lesion | Failed R cath | bRSI 1.1 sRSI 1.1 |
2 | bRSI 1.7 sRSI 105 |
Success but no lateralization: MRA therapy |
| 15 | No lesion | Failed R cath | bRSI 1.2 sRSI 0.9 |
2 | bRSI 2.4 sRSI 31.8 |
Success but no lateralization: MRA therapy |
| 16 | 16 mm R | Contralateral LI | bLI 2.7 (L) sLI 6.6 (L) |
3 | bLI 2.0 (L) sLI 1.5 (L) |
Same resultsa,b NP-59–positive mass, DHEAS suppressed. Surgery refused because of severe obesity |
| 17 | No lesion | Lateralization with no mass | bLI 3.9 (R) sLI 1.35 (R) |
20 | bLI 2.1 (R) sLI 1.94 (L) |
Success but no lateralization: MRA therapy |
| 18 | 10 mm L | Contralateral LI | bLI 7.4 (R) sLI 6.6 (R) |
3 | bLI 11.0 (R) sLI 7.0 (R) |
Same results; R ADx. Pathology 0.9-cm adrenal mass, no hyperplasia. Normal ARR, BP improved |
| 19 | 24 mm L | Contralateral LI | bLI 11.8 (R) sLI 4.7 (R) |
3 | bLI 3.1 (R) sLI 2.4 (R) |
Same resultsa,b NP59-positive, ACTH suppressed. L ADx; postop ACTH now high but ARR still high with hypertension |
| 20 | 18 mm L | Discordant— nonlateralizing | bLI 1.8 (L) sLI 3.2 (R) |
1 | bLI 12.0 (R) sLI 1.6 (R) |
Same results |
| 21 | 29 mm R | Contralateral LI | bLI 2.8 (L) sLI 3.4 (L) |
4 | bLI 1.4 (L) sLI 1.9 (L) |
Same resultsa |
| 22 | No lesion | Failed R cath | bRSI 0.9 sRSI 1.0 |
3 | bRSI 0.7 sRSI 1.6 |
Failed AVS |
| 23 | 28 mm L | Contralateral LI | bLI 4.7 (R) sLI 1.1 (R) |
47 | bLI 2.0 (R) sLI 2.4 (L) |
Same results (basal)a,b NP-59–positive mass, surgery L mass, normal ARR and BP improved |
Abbreviations: ACTH, adrenocorticotropin; ADx, adrenalectomy; ARR, aldosterone-renin ratio; AVS, adrenal vein sampling; bLI, basal lateralization index; bLSI, basal left selectivity index; BP, blood pressure; bRSI, basal right selectivity index; cath, catheterization; CT, computed tomography; DHEAS, dehydroepiandrosterone sulfate; L, left; MRA, mineralocorticoid receptor antagonist; NP-59, 131I-iodocholesterol; R, right; sLI, stimulated lateralization index; sLSI, stimulated left selectivity index; sRSI, stimulated right selectivity index.
a Query cortisol cosecretion.
b See Supplementary material for more case details.