Adrenal Venous Sampling in Primary Hyperaldosteronism

Adrenal venous sampling (AVS) is used to distinguish unilateral from bilateral aldosterone hypersecretion as a cause of primary hyperaldosteronism (PHA). This distinction is critical because unilateral disease is treated, and often cured, by adrenalectomy, whereas bilateral hypersecretion should be managed medically. In this article, we review the epidemiology and etiologies of PHA, present screening guidelines for hypertensive patients with suspected PHA, assess the utility and pitfalls of cross-sectional imaging, and discuss the indications for and interpretation of AVS.