Table 1

Suggested presentation of AVS data for report to clinician and radiologist. Data are from a 40-year-old female who presented with hypertension and low to low-normal potassium (K=3.0–3.9 mmol/L). Her screening plasma aldosterone was 882 pmol/L with a renin concentration of 2.6 ng/L for an ARR of 339 (N < 50). Saline suppression was performed as per standard approach.4 Post-saline aldosterone was 135 pmol/L (N < 138 pmol/L, 5 ng/dL). Given the borderline response to saline, the strongly positive screening data and the ongoing hypokalaemia, AVS was pursued, which showed clear left lateralisation. CT scan showed normal adrenals but possible thickening of the medial limb of the left adrenal without nodularity. Left adrenalectomy showed a 0.7 cm well-circumscribed lipid rich adenoma. The data illustrate a number of instructional points described above.

Collection timeLocationAldosterone
10:54Right adrenal pre-ACTH3702942.2Yes1.3
10:55Left adrenal pre-ACTH46201841.4Yes*25.120.0 L:R
10:56IVC pre-ACTH1291351.0
11:20Right adrenal post-ACTH19 10011 20034.0Yes1.7
11:23Left adrenal post-ACTH113 000759023.1Yes14.98.7 L:R
11:21IVC post-ACTH6973292.1
  • *First, the unstimulated LAV specimen does not meet the standard selectivity threshold of SI=2.0 but is clearly sampling the LAV effluent based on its aldosterone concentration of 4620 pmol/L. Its cortisol result is also lower than the right (184 vs 294 nmol/L) presumedly because dilution from the inferior phrenic vein. Second, the IVC aldosterone from the unstimulated collection is lower than the saline suppression threshold of 138 pmol/L. Third, the SIs are much improved and far above the selectivity threshold of 3.0 after ACTH stimulation, while the LI decreases from 20.0 to 8.7 in response to ACTH. Also of note, the RAV shows contralateral suppression.

  • A/C, aldosterone:cortisol ratio; ACTH, (1-24)adrenocorticotropic hormone; LI, lateralisation index; SI, selectivity index; L:R, left:right.