Using Point of Care Rapid Cortisol Measurement During Adrenal Venous Sampling in Primary Hyperaldosteronism

Abstract

Objectives: To assess success rates and cost-effectiveness of adrenal venous sampling (AVS) after implementing point-of-care rapid cortisol (RC) testing conducted using a europium nanoparticle-based fluoro-immunoassay in patients with primary hyperaldosteronism. Methods: A retrospective review of AVS procedures was conducted at our medical center between January 2016 and June 2024. The primary objective was to compare the success rates of AVS before and after the implementation of the RC testing. Secondary outcomes included a cost–benefit analysis. Results: Of 55 AVS procedures, 19 were conducted using RC testing and 36 were in the historical control cohort. The success rates for right vein sampling were 79% and 67%, respectively. Overall, in six (31.5%) patients in the RC cohort, a low RC selectivity index (SI) value, calculated within 10 min, enabled determination of unsuccessful cannulation and need for resampling during the same AVS session. Repeated sampling resulted in successful procedures in two cases (10.5%) and unsuccessful AVS in four cases, nonetheless sparing the need for repeated AVS sessions in 31.5% of cases. Utilizing RC potentially spared 6 patients from repeated AVS sessions, and considering the additional expenses on the RC test, its use afforded cost savings of an average of $1288 per patient. Conclusions: We demonstrated the cost-effectiveness of utilizing RC measurement in sparing the need for repeated AVS sessions. RC measurement during AVS enabled identification of correct catheter placement in real time, allowing for prompt decisions regarding the need for additional sampling attempts, thereby reducing subsequent costs of repeated AVS sessions.