Adrenal venous sampling as a diagnostic procedure for primary hyperaldosteronism: experience from a tertiary referral centre

Abstract

cONtEXt: Adrenal vein sampling (AVs) is recommended in all patients with hyperaldosteronism to whom surgery would be offered if the results indicated unilateral hypersecretion. ObJEctIVE: to assess the performance of AVs against radiological findings and to evaluate the Endocrine society's Practice Guidelines for diagnostic cut-offs. PAtIENts: retrospective study of 41 patients with hyperaldosteronism who underwent both AVs and computed tomography (ct) imaging. rEsULts: ct and AVs results were concordant in 73.7%. Unilateral lesions on ct had a greater positive predictive value (85%) than non-unilateral lesions (50%). In patients with subsequently confirmed adrenal adenomas, a lateralisation ratio >2 when comparing cortisol-corrected aldosterone ratios from the affected versus unaffected side was 100% sensitive. Patients who were managed surgically experienced significant reductions in blood pressure and medication burden and 46% were cured. cONcLUsIONs: AVs is important in establishing unilateral or bilateral adrenal secretion of aldosterone in patients with primary hyperaldosteronism. However, it may not be essential for the work-up in patients below the age of 40, in whom adrenal incidentalomas adrenal incidentalomas are known to be rarer, and a unilateral lesion on ct therefore has a greater positive predictive value.

Comparison between adrenal venous sampling and computed tomography in the diagnosis of primary aldosteronism and in the guidance of adrenalectomy

“…Our finding suggests that 30 years might be the proper age for not having AVS, as appropriate. Our finding is slightly different from the results of several recent studies [15,21] and the current recommendations. [14] In the aforementioned study from Lim et al, [15] the authors proposed 35 years as the age limit for exemption of AVS according to 100% of concordance rate between AVS and adrenal CT imaging in 6 patients of 35.1 years or younger.…”

“…[12,19–21] In a study of 62 patients with primary aldosteronism, 38 had adrenal CT imaging and successful bilateral AVS. In patients with AVS proven adrenal producing adenoma (n = 15) and bilateral adrenal hyperplasia (n = 21), respectively, only 8 and 4 had concordant findings with CT imaging.…”

“…[20] Similarly, in a retrospective analysis of 41 patients with primary aldosteronism, unilateral (n = 26) but not nonunilateral lesions on CT (n = 12) had a high positive predictive value of AVS-proven adrenal lesions (85% vs 50%). [21] …”

“…In a recent study of 41 patients with primary aldosteronism, 16 were 40 years or younger. [21] Eleven had adrenal CT unilateral lesions. One patient declined surgery.…”

Success in adrenal venous sampling between two protocols: experience at a tertiary centre

“…Although the sample size is comparable to the existing published studies, we acknowledge the absence of head-to-head comparison of AVS with and without cosyntropin stimulation 5 8. The purpose of our study was to assess how we are performing the AVS procedures and whether change in strategy would prove beneficial to the clinicians as well as the patients.…”