Primary aldosteronism is one of the most common surgically curable types of secondary hypertension. Patients with unilateral hyper-secretion of aldosterone are usually treated by unilateral total adrenalectomy, while those with bilateral involvement are medically treated. Therefore, adrenal venous sampling is essential to differentiate between unilateral and bilateral primary aldosteronism, and to decide how to treat patients with primary aldosteronism. When performing adrenal venous sampling, it is very important to obtain adrenal effluents at the central vein of each adrenal gland without contamination of extra-adrenal blood.
In this paper, I would like to present the methods of adrenal venous sampling to obtain adrenal effluents at central veins by using specific micro-catheter and ACTH stimulation. Moreover, I would like to mention segmental adrenal tributary sampling to obtain adrenal effluents at more than two tributary veins in each adrenal gland.

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Primary aldosteronism is reported to occur in 5% to 10% of hypertensive patients and is far from a rare pathological condition. Therapeutic strategies for this condition vary depending on whether the aldosterone hypersecretion is from the right adrenal gland, left adrenal gland, or both adrenal glands. In the case of unilateral aldosterone hypersecretion, cure can be expected by adrenalectomy. Adrenal venous sampling, which allows direct assessment of the function of the right and left adrenal glands, plays an important role in the localization of the lesion and determination of the surgical indication.
For a successful sampling procedure, it is important to closely examine the vascular anatomy by contrast-enhanced computed tomography (CT) prior to the procedure, to prevent complications, and to use innovative techniques in difficult cases. This article presents these points based on the recent literature and our experience.

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Pancreatic neuroendocrine tumors constitute a wide variety of rare lesions. They are named according to the hormones that they produce. It is sometimes very difficult to localize pancreatic neuroendocrine tumors by conventional imaging techniques. To perform a curative resection of such neuroendocrine tumors, it is important to remove the entire tumor completely. SACI test is a highly sensitive investigation for the localization of insulinomas and gastrinomas. Its major advantage over other investigations is that the venous sampling provides functional data that confirm that a visualized abnormality is a functioning tumor. The rarity of these tumors means that reports of SACI test are limited to case studies and relatively small series, but the technique is extremely useful in patients with insulinomas and gastrinomas. There are good arguments for its performance in all patients being considered for curative surgical resection. Here we describe the technical aspects of SACI test, potential pitfalls, and our clinical experience.

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Ultrasound, CT, MRI and sestamibi scintigraphy are recently the main stream of the diagnostic imaging for primary hyperparathyroidism, however, the focus is not identified in 10-20% of the cases. Furthermore, a discrepancy of diagnostic imaging will be sometimes observed among these modalities. Although the selective venous sampling (SVS) of the parathyroid gland is a classical method to identify the functioning nodule of this entity, SVS using a microcatheter can identify the precise location of the functioning nodules. Here we describe the role and technique of modern SVS.

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Cushing syndrome is characterized by elevated levels of circulating corticosteroids. In the majority of cases, it is caused by hypersecretion of corticotropin by the pituitary gland (Cushing disease). Selective venous sinus sampling is considered to be the gold standard for confirming the origin of ACTH secretion in patients with Cushing syndrome. We explain the procedure for precise results in relation to venous anatomy of cavernous sinus in selective venous sampling.

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In Japan, adrenal venous sampling is widely performed in many institutions by interventional radiologists. However, the current status of adrenal venous sampling is unclear because this procedure was not covered by health insurance, and this procedure was not registered before 2012. Therefore we distributed a questionnaire about this procedure among the 224 training institutions qualified by the Japanese Society of Interventional Radiology at the end of 2012. Responses were obtained from 83 institutions. The majority of institutions performed fewer than 20 cases of adrenal venous sampling per year. The details of specific methodologies for adrenal venous sampling, including adrenal corticotrophic hormone stimulation, collaboration with an internal medicine doctor, as well as use of introducers, catheters, and micro-catheters, varied within each institution. However, the success rates of adrenal venous sampling were 97% on the right side, 100% on the left side, and 96% on both sides. Most angiographers thought venous sampling of the right adrenal gland was more difficult than sampling of the left. The examination time for sampling ranged from 60 to 120 minutes.
The questionnaire revealed the present status of adrenal venous sampling in Japan. The details of this technique in each institution varied, but the results were satisfactory in most cases.

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