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Peer-reviewedCC BYEndocrinology, diabetes & metabolism case reports

Apparent bilateral aldosterone suppression during adrenal venous sampling associated with preferential drainage into the left inferior phrenic vein.

  • Tomoko Nishigaki1
  • Masaaki Yamamoto2
  • Yuichi Higuchi1
  • Kei Yoshino1
  • Hironori Bando1
  • Keigo Matsushiro3
  • Tomoyuki Gentsu3
  • Keitaro Sofue3
  • Maki Kanzawa4
  • Wataru Ogawa2
  • Hidenori Fukuoka1
4 affiliations
  1. 1Division of Diabetes and Endocrinology, Department of Internal Medicine, Kobe University Hospital , Kobe, Japan.
  2. 2Division of Diabetes and Endocrinology, Department of Internal Medicine, Kobe University Graduate School of Medicine , Kobe, Japan.
  3. 3Department of Diagnostic and Interventional Radiology, Kobe University Hospital , Kobe, Japan.
  4. 4Department of Diagnostic Pathology, Kobe University Hospital , Kobe, Japan.
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Abstract

Summary

A 54-year-old woman with primary aldosteronism caused by left adrenal adenoma underwent adrenal venous sampling (AVS) for subtype classification and unexpectedly exhibited bilateral aldosterone suppression (BAS) despite adequate selectivity. BAS on AVS is a recognized diagnostic pitfall that can obscure surgically curable unilateral diseases, particularly left-sided cases. In this case, venous anatomy was carefully reassessed considering the inconclusive AVS findings. Although adrenal arteriography is infrequently used in the diagnostic workup of primary aldosteronism, it was incorporated as an adjunct to assess venous anatomy. No additional drainage route was identified on the obtained angiographic images, and the cranial and medial superficial location of the tumor in close proximity to the left inferior phrenic vein raised the suspicion of preferential drainage into this vessel. Although the complete tumor-drainage pathway was not directly visualized, targeted venous sampling based on this anatomical hypothesis enabled accurate lateralization of a unilateral disease. This case underscores interpreting BAS within the context of venous anatomy, particularly on the left side, rather than as definitive evidence of bilateral primary aldosteronism.Learning points

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Cite

BibTeXRIS
BibTeX
@article{nishigaki2026apparent,
  title = {{Apparent bilateral aldosterone suppression during adrenal venous sampling associated with preferential drainage into the left inferior phrenic vein.}},
  author = {Tomoko Nishigaki and Masaaki Yamamoto and Yuichi Higuchi and Kei Yoshino and Hironori Bando and Keigo Matsushiro and Tomoyuki Gentsu and Keitaro Sofue and Maki Kanzawa and Wataru Ogawa and Hidenori Fukuoka},
  journal = {Endocrinology, diabetes \& metabolism case reports},
  year = {2026},
  month = oct,
  doi = {10.1530/edm-26-0013},
  url = {https://europepmc.org/article/MED/42831590},
  note = {CC BY},
}
RIS
TY  - JOUR
TI  - Apparent bilateral aldosterone suppression during adrenal venous sampling associated with preferential drainage into the left inferior phrenic vein.
AU  - Tomoko Nishigaki
AU  - Masaaki Yamamoto
AU  - Yuichi Higuchi
AU  - Kei Yoshino
AU  - Hironori Bando
AU  - Keigo Matsushiro
AU  - Tomoyuki Gentsu
AU  - Keitaro Sofue
AU  - Maki Kanzawa
AU  - Wataru Ogawa
AU  - Hidenori Fukuoka
PY  - 2026
DA  - 2026/10/01
JO  - Endocrinology, diabetes & metabolism case reports
DO  - 10.1530/edm-26-0013
UR  - https://europepmc.org/article/MED/42831590
AB  - Summary  A 54-year-old woman with primary aldosteronism caused by left adrenal adenoma underwent adrenal venous sampling (AVS) for subtype classification and unexpectedly exhibited bilateral aldosterone suppression (BAS) despite adequate selectivity. BAS on AVS is a recognized diagnostic pitfall that can obscure surgically curable unilateral diseases, particularly left-sided cases. In this case, venous anatomy was carefully reassessed considering the inconclusive AVS findings. Although adrenal arteriography is infrequently used in the diagnostic workup of primary aldosteronism, it was incorporated as an adjunct to assess venous anatomy. No additional drainage route was identified on the obtained angiographic images, and the cranial and medial superficial location of the tumor in close proximity to the left inferior phrenic vein raised the suspicion of preferential drainage into this vessel. Although the complete tumor-drainage pathway was not directly visualized, targeted venous sampling based on this anatomical hypothesis enabled accurate lateralization of a unilateral disease. This case underscores interpreting BAS within the context of venous anatomy, particularly on the left side, rather than as definitive evidence of bilateral primary aldosteronism.Learning points
SN  - 2052-0573
ER  -