Left adrenal aldosteronism coexisting with left paraaortic paraganglioma presenting as bilateral adrenal and left paraaortic tumors– comprehensive adrenal evaluation aiding perfect management: a case report

Table 2 Adrenal venous sampling result

AVS^a	IVC	Right	Left
Pre-ACTH stimulation
Aldosterone (pg/ml)	1036/1080	676/625	9219/9319
Cortisol (μg/dl)	13.80/13.70	19.10/18.90	47.36/43
Aldosterone/Cortisol	75.07/78.83	35.39/33.07	194.90/216.72
Selectivity index		1.38^b/1.38^b	3.43/3.14
Relative secretion index		0.47/0.42	2.60/2.75
Lateralization index			5.51/6.55
Contralateral suppression index		0.47/0.42
Post-ACTH stimulation
Aldosterone (pg/ml)	1418/1222	6252/5719	12,388/19962
Cortisol (μg/dl)	17.90/18.30	937/968	346/506
Aldosterone/Cortisol	79.22/66.78	6.67/5.91	35.8/39.45
Selectivity index		52.35/52.90	19.32/27.65
Relative secretion index		0.08/0.09	0.45/0.59
Lateralization index			5.63/6.56
Contralateral suppression index		0.08/0.09

AVS Adrenal venous sampling, IVC Inferior vena cava, ACTH Adrenal corticotropic hormone, Selectivity index \(\left(\frac{{\mathrm{Cortisol}}_{\;\mathrm{side}}}{{\mathrm{Cortisol}}_{\;\mathrm{IVC}}}\right)\), Relative secretion index \(\left(\frac{{\mathrm{Aldosterone}}_{\;\mathrm{side}}/{\mathrm{Cortisol}}_{\;\mathrm{side}}}{{\mathrm{Aldosterone}}_{\;\mathrm{IVC}}/{\mathrm{Cortisol}}_{\;\mathrm{IVC}}}\right)\), Lateralization index \(\left(\frac{\mathrm{Aldosterone}\;_{\mathrm{dominant}}/{\mathrm{Cortisol}}_{\;\mathrm{dominant}}}{{\mathrm{Aldosterone}}_{\;\mathrm{nondominant}}/{\mathrm{Cortisol}}_{\;\mathrm{nondominant}}}\right)\), Contralateral suppression index \(\left(\frac{{\mathrm{Aldosterone}}_{\;\mathrm{nondominant}}/{\mathrm{Cortisol}}_{\;\mathrm{nondominant}}}{{\mathrm{Aldosterone}}_{\;\mathrm{IVC}}/{\mathrm{Cortisol}}_{\;\mathrm{IVC}}}\right)\)
^aAdrenal venous sampling was done twice before and after ACTH stimulation and revealed left lateralization by lateralization index and contralateral suppression index
^bSuccessful catheterization confirmed except pre-ACTH stimulation right adrenal vein sampling (positive cutoff value > 2x)

ISSN: 1472-6823