LBPS 02-37 ADRENAL HEMORRHAGE FOLLOWING ADRENAL VEIN SAMPLING IN PRIMARY ALDOSTERONISM: A SIX-CENTER EXPERIENCE.

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Abstract

Objective:

Adrenal vein sampling (AVS) is the only reliable means to distinguish between aldosterone-producing adenoma and bilateral adrenal hyperplasia, the two most common subtype of primary aldosteronism (PA). A rare but serious complication of AVS is an adrenal hemorrhage (AH).

Design and Method:

We retrospectively evaluated 24 cases of AH after AVS that occurred in 6 tertiary referral hypertension centers in Italy, Germany, Japan and Australia. The control group comprised 1388 PA patients who underwent AVS in the different centers participating in the study during a similar period of time as when the patients experienced AH during AVS.

Results:

In our case-series, AH more often affected the right adrenal (nY=Y18) than the left (nY=Y5, PY10 years) and less experienced radiologists. Of 9 AH in the gland contralateral to an aldosterone-producing adenoma and who underwent complete (nY=Y6) or partial (nY=Y3) unilateral adrenalectomy, only one resulted in adrenal insufficiency and the patient required long-term corticosteroid replacement therapy. No reduction in blood pressure or biochemical resolution of PA occurred in any of those patients who experienced AH in the gland ipsilateral to an aldosterone-producing adenoma (nY=Y6) or who had bilateral adrenal hyperplasia (nY=Y9). No patient required blood transfusion or invasive approaches to control bleeding.

Conclusions:

In conclusion, AH usually has a positive outcome and AVS should remain the preferred approach to subtype differentiation in PA patients.

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