Primary aldosteronism (a.k.a. primary hyperaldosteronism): Hypersecretion of aldosterone by adrenal glands
Adrenal adenoma (Conn syndrome): Cause in 2/3 of cases
Bilateral idiopathic adrenal hyperplasia: Cause in remaining 1/3 of cases
Cushing syndrome: Clinical complex resulting from prolonged inappropriate exposure to glucocorticoids
Most frequently caused by administration of exogenous glucocorticoids or adrenocorticotrophic hormone (ACTH)
Endogenous causes include ACTH-secreting pituitary tumor, adrenal neoplasm (benign or malignant), or ectopic ACTH secretion by tumor
Adrenal Vein Anatomy
In most individuals, each gland has single main vein
Multiple adrenal veins occasionally occur
Adrenal veins communicate with retroperitoneal and renal capsular veins
Right adrenal vein drains directly into right posterolateral aspect of IVC
Typically located 2-4 cm above right renal vein
Small accessory hepatic vein may rarely drain into right adrenal vein or vice versa (10% incidence)
Left adrenal vein drains into superior aspect of left renal vein
Typically located 3-5 cm from left renal vein orifice
May very rarely drain directly into IVC
Renal Vein Anatomy
Usually each kidney is drained by single renal vein
Renal veins rarely have valves
Communicate with other retroperitoneal veins (e.g., lumbar, azygos, gonadal veins)
Left renal vein courses anterior to aorta and posterior to SMA to join IVC
Left renal vein drains somewhat anteriorly into IVC
Right renal vein is shorter, drains into IVC at about L2 vertebral level
Frequent variations in renal venous anatomy
PREPROCEDURE
Indications
Contraindications
Preprocedure Imaging
Getting Started
PROCEDURE
Patient Position/Location
Procedure Steps
Findings and Reporting
Alternative Procedures/Therapies
POST PROCEDURE
Expected Outcome
Things to Do
Things to Avoid
OUTCOMES
Problems
Complications
Selected References
Rossi GP et al: An expert consensus statement on use of adrenal vein sampling for the subtyping of primary aldosteronism. Hypertension. 63(1):151-60, 2014
Primary aldosteronism (a.k.a. primary hyperaldosteronism): Hypersecretion of aldosterone by adrenal glands
Adrenal adenoma (Conn syndrome): Cause in 2/3 of cases
Bilateral idiopathic adrenal hyperplasia: Cause in remaining 1/3 of cases
Cushing syndrome: Clinical complex resulting from prolonged inappropriate exposure to glucocorticoids
Most frequently caused by administration of exogenous glucocorticoids or adrenocorticotrophic hormone (ACTH)
Endogenous causes include ACTH-secreting pituitary tumor, adrenal neoplasm (benign or malignant), or ectopic ACTH secretion by tumor
Adrenal Vein Anatomy
In most individuals, each gland has single main vein
Multiple adrenal veins occasionally occur
Adrenal veins communicate with retroperitoneal and renal capsular veins
Right adrenal vein drains directly into right posterolateral aspect of IVC
Typically located 2-4 cm above right renal vein
Small accessory hepatic vein may rarely drain into right adrenal vein or vice versa (10% incidence)
Left adrenal vein drains into superior aspect of left renal vein
Typically located 3-5 cm from left renal vein orifice
May very rarely drain directly into IVC
Renal Vein Anatomy
Usually each kidney is drained by single renal vein
Renal veins rarely have valves
Communicate with other retroperitoneal veins (e.g., lumbar, azygos, gonadal veins)
Left renal vein courses anterior to aorta and posterior to SMA to join IVC
Left renal vein drains somewhat anteriorly into IVC
Right renal vein is shorter, drains into IVC at about L2 vertebral level
Frequent variations in renal venous anatomy
PREPROCEDURE
Indications
Contraindications
Preprocedure Imaging
Getting Started
PROCEDURE
Patient Position/Location
Procedure Steps
Findings and Reporting
Alternative Procedures/Therapies
POST PROCEDURE
Expected Outcome
Things to Do
Things to Avoid
OUTCOMES
Problems
Complications
Selected References
Rossi GP et al: An expert consensus statement on use of adrenal vein sampling for the subtyping of primary aldosteronism. Hypertension. 63(1):151-60, 2014