Adrenal vein sampling may not be a gold-standard diagnostic test in primary aldosteronism: final diagnosis depends upon which interpretation rule is used

Kline, Gregory; Harvey, Adrian; Jones, Charlotte; Hill, Michael H.; So, Benny; Scott-Douglas, Nairne; Pasieka, Janice L.

doi:10.1007/s11255-008-9441-9

Cited by 53 publications

(42 citation statements)

References 23 publications

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“…11,36,37,[73][74][75] Compared with the higher rate of complications reported in those previous studies, a recent global multicenter study involving major referral centers, the AVIS, demonstrated that the rate of adrenal vein rupture was 0.61%. 13 This decrease is likely attributable, at least in part, to avoiding routine adrenal venography and minimizing the injection volume for anatomic confirmation of the adrenal vein catheterization.…”

Section: Safety and Management Of Complicationsmentioning

confidence: 99%

An Expert Consensus Statement on Use of Adrenal Vein Sampling for the Subtyping of Primary Aldosteronism

et al. 2014

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Abstract-Adrenal venous sampling is recommended by current guidelines to identify surgically curable causes of hyperaldosteronism but remains markedly underused. Key factors contributing to the poor use of adrenal venous sampling include the prevailing perceptions that it is a technically challenging procedure, difficult to interpret, and can be complicated by adrenal vein rupture. In addition, the lack of uniformly accepted standards for the performance of adrenal venous sampling contributes to its limited use. Hence, an international panel of experts working at major referral centers was assembled to provide updated advice on how to perform and interpret adrenal venous sampling. To this end, they were asked to use the PICO (Patient or Problem, Intervention, Control or comparison, Outcome) strategy to gather relevant information from the literature and to rely on their own experience. The level of evidence/recommendation was provided according to American Heart Association gradings whenever possible. A consensus was reached on several key issues, including the selection and preparation of the patients for adrenal venous sampling, the procedure for its optimal performance, and the interpretation of its results for diagnostic purposes even in the most challenging

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Section: Safety and Management Of Complicationsmentioning

confidence: 99%

An Expert Consensus Statement on Use of Adrenal Vein Sampling for the Subtyping of Primary Aldosteronism

et al. 2014

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“…Kline et al 19 compared 10 different AVS protocols (with or without cosyntropin stimulation) in 63 patients. The success rate of AVS ranged between 13% and 77%, according to the SI used, and only 17% of patients were uniformly classified by all diagnostic criteria (8% as having bilateral aldosterone excess and 9% as having unilateral aldosterone excess).…”

Section: Comparison With Previous Studies and Interpretation Of Our Rmentioning

confidence: 99%

Influence of Diagnostic Criteria on the Interpretation of Adrenal Vein Sampling

et al. 2015

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P atients with primary aldosteronism (PA) have either bilateral (idiopathic hyperplasia) or unilateral (aldosterone-producing adenoma or unilateral hyperplasia) adrenal disease. 1,2 Localizing the source of excessive aldosterone secretion is critical to select the appropriate therapy. Unilateral PA can be treated by laparoscopic adrenalectomy, which normalizes serum potassium concentrations in almost all cases and cures or improves hypertension in >80% of patients.3,4 By contrast, medical management with mineralocorticoid receptor antagonists is recommended as the first-line treatment in bilateral PA. 5Adrenal vein sampling (AVS) is currently considered the gold standard to differentiate unilateral from bilateral aldosterone hypersecretion and is recommended in almost all patients with PA who are eligible for surgical management. 5,6 The accuracy of catheter placement in the adrenal veins can be verified from the cortisol concentration in the adrenal veins divided by that in the inferior vena cava or a peripheral vein (selectivity index [SI]). If the SI reaches the predefined cut-off, the lateralization index (LI) is then used to classify PA into unilateral or bilateral disease. The LI is defined as the highest aldosterone/ cortisol concentration ratio (dominant adrenal vein) divided by the lowest aldosterone/cortisol concentration ratio (nondominant adrenal vein). Some investigators also propose the use of the contralateral suppression index, defined by the aldosterone/ cortisol concentration ratio of the nondominant adrenal vein divided by the peripheral aldosterone/cortisol concentration ratio.7 However, the protocol of AVS (simultaneous or sequential bilateral AVS, use of cosyntropin or not, and the protocol of cosyntropin infusion) and the SI and LI cut-offs used to interpret the results are not currently standardized. 7-9We have interpreted a large number of AVS procedures with criteria used in 4 reference centers or proposed by a recent consensus statement. 6,[10][11][12] The first objective of this study was to examine to which extent the interpretation of AVS may differ according to the criteria used for its interpretation. The second goal was to assess the reproducibility of this interpretation when multiple blood samples were drawn from the same adrenal vein. Methods PatientsThis retrospective study included all patients who underwent AVS in our hypertension referral center between January 2001 and July Abstract-Guidelines promote the use of adrenal vein sampling (AVS) to document lateralized aldosterone hypersecretion in primary aldosteronism. However, there are large discrepancies between institutions in the criteria used to interpret its results. This study evaluates the consequences of these differences on the classification and management of patients. The results of all 537 AVS procedures performed between January 2001 and July 2010 in our institution were interpreted with 4 diagnostic criteria used in experienced institutions where AVS is performed without cosyntropin (Brisbane, Padua, Paris, an...

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“…To minimize the impact of these factors, ACTH infusion was introduced by Weinberger et al (22) and widely used thereafter (21,23,24), thus being held as an essential part of the sequential AVS (11,19,21,25), or even of bilaterally simultaneous AVS (5,26,27). In our hands, cosyntropin stimulation confounded the assessment of lateralization and led to misclassification of the APA side (8,17).…”

Section: Impact Of Sequential or Simultaneous Avs On Si Valuementioning

confidence: 80%

A stress reaction affects assessment of selectivity of adrenal venous sampling and of lateralization of aldosterone excess in primary aldosteronism

Seccia

Miotto²,

Battistel³

et al. 2012

European Journal of Endocrinology

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Background: A stress reaction involving increased cortisol release, which has not been documented thus far, might affect the assessment of selectivity of catheterization during adrenal venous sampling (AVS). Objective: To investigate whether an ACTH-driven cortisol release occurs during AVS and whether it influences the assessment of selectivity by the step-up of cortisol (plasma cortisol concentrations, PCC) between the adrenal vein blood (PCC SIDE ) and the inferior vena cava (PCC IVC ), e.g. the selectivity index (SI). Design and methods: We determined the SI in samples obtained simultaneously at starting AVS (t-15) and again after 15 min (t0) in 34 consecutive patients with proven aldosterone-producing adenoma. We then calculated the SI with PCC SIDE obtained at t-15 and at t0, and the PCC IVC values obtained at the different time point, thus simulating sequential AVS. Results: The PCC SIDE and the SI fell significantly from t-15 to t0 on both the sides. When PCC SIDE obtained at t-15 was combined with PCC IVC at t0, the SI values were higher than those obtained with simultaneously drawn samples. This led to label as selective more AVS studies than with bilaterally simultaneous data, especially when using higher cutoffs for the SI. Conclusions: A transient increase in cortisol release from both adrenal glands occurs in the majority of the patients who undergo AVS. This stress reaction can influence the assessment of both the selectivity of the catheterization during the sequential AVS technique and the lateralization of aldosterone excess.

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Adrenal vein sampling may not be a gold-standard diagnostic test in primary aldosteronism: final diagnosis depends upon which interpretation rule is used

Abstract: We found substantial variabilty in final diagnosis by using different systems of interpreting AVS results as suggested in the literature This suggests AVS may not always be considered a gold-standard diagnostic test.

Cited by 53 publications

References 23 publications

An Expert Consensus Statement on Use of Adrenal Vein Sampling for the Subtyping of Primary Aldosteronism

An Expert Consensus Statement on Use of Adrenal Vein Sampling for the Subtyping of Primary Aldosteronism

Influence of Diagnostic Criteria on the Interpretation of Adrenal Vein Sampling

A stress reaction affects assessment of selectivity of adrenal venous sampling and of lateralization of aldosterone excess in primary aldosteronism

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