Rapid, semi-quantitative, gold nanoparticle-based cortisol measurement during adrenal vein sampling significantly improves procedural success rate in a specialist centre

ObjectiveAdrenal vein sampling (AVS) is considered the gold standard in the differential diagnosis of primary aldosteronism (PA), but success rates vary between centers. We hypothesized that rapid (intraprocedure) cortisol measurement can improve performance in a center with initially low AVS success rate.DesignWe analyzed 46 patients with confirmed PA studied between 2008 and 2010. Forty-seven PA patients studied between 2004 and 2008 identified by retrospective chart review served as controls. All patients were treated at a single tertiary care university hospital.MethodsStarting in 2008, rapid cortisol assays (RCA) were performed in all patients during the AVS procedure. A cortisol gradient of ≥2.0 between adrenal vein and a femoral vein sample was used as success criterion. Up to two repeat samples were drawn if adrenal vein cortisol was below this threshold.ResultsDuring the control period 26 of 47 AVS were successful (55%). After introduction of RCA, 39 out of 46 AVS (85%) were successful (P=0.003). In 21 of the 46 cases (46%) a resampling was necessary. The increase in overall success was due to an increase in successful right AVS (85 vs 62% before introduction of RCA; P=0.02) and a training effect (P=0.024 for trend).ConclusionRCA during AVS are useful in centers with an initially low AVS success rate.

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Rapid Cortisol Assays Improve the Success Rate of Adrenal Vein Sampling for Primary Aldosteronism

Annals of Surgery ◽

10.1097/sla.0b013e3181961d77 ◽

2009 ◽

Vol 249 (2) ◽

pp. 318-321 ◽

Cited By ~ 62

Author(s):

Richard J. Auchus ◽

Christina Michaelis ◽

Frank H. Wians ◽

Bart L. Dolmatch ◽

Shellie C. Josephs ◽

...

Keyword(s):

Success Rate ◽

Primary Aldosteronism ◽

Adrenal Vein ◽

Adrenal Vein Sampling

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Feasibility and effectiveness of a single-catheter approach for adrenal vein sampling in patients with primary aldosteronism

BMC Endocrine Disorders ◽

10.1186/s12902-021-00685-x ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Jindong Wan ◽

Fei Ran ◽

Siwei Xia ◽

Jixin Hou ◽

Dan Wang ◽

...

Keyword(s):

Learning Curve ◽

Primary Aldosteronism ◽

Adrenal Vein ◽

Complication Rates ◽

Cumulative Number ◽

Puncture Site ◽

Adrenal Vein Sampling ◽

Operation Period ◽

Femoral Puncture ◽

Procedural Success

Abstract Background Adrenal vein sampling (AVS) is the preferred method for subtyping patients with primary aldosteronism, while the procedure is technically challenging. This study evaluated the feasibility and effectiveness of a single-catheter approach for AVS. Methods A retrospective analysis of 106 consecutive patients who underwent AVS was performed to determine the procedural success and complication rates. Bilateral AVS procedures were performed using a single 5-Fr Tiger catheter with repeated manual reshaping. Results We successfully advanced the catheter into the bilateral adrenal veins of all patients and reached a 90.6% procedural success rate of AVS. The procedural period was 33.0 ± 8.2 min, the fluoroscopy period was 5.8 ± 1.7 min, and the diagnostic contrast used was 17.3 ± 5.5 ml. Only one patient (0.9%) had a hematoma at the femoral puncture site. No other complications were observed. The operation period gradually shortened as the cumulative number of operations increased. The number of procedures required to overcome the learning curve was about 33 cases. Conclusions The single-catheter approach is feasible and effective for AVS. Moreover, this approach required a relatively short learning curve for an inexperienced trainee.

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Abstract No. 236: Rapid Cortisol Assays Increase Success Rate of Adrenal Vein Sampling

Journal of Vascular and Interventional Radiology ◽

10.1016/j.jvir.2008.12.230 ◽

2009 ◽

Vol 20 (2) ◽

pp. S91

Author(s):

M.E. Anderson ◽

C.K. Trimmer ◽

S.C. Josephs ◽

B.L. Dolmatch ◽

R.J. Auchus ◽

...

Keyword(s):

Success Rate ◽

Adrenal Vein ◽

Adrenal Vein Sampling ◽

Increase Success Rate

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Intraprocedural Cortisol Measurement Increases Adrenal Vein Sampling Success Rate in Primary Aldosteronism

Yearbook of Endocrinology ◽

10.1016/j.yend.2012.05.013 ◽

2012 ◽

Vol 2012 ◽

pp. 273-274

Author(s):

D.E. Schteingart

Keyword(s):

Success Rate ◽

Primary Aldosteronism ◽

Adrenal Vein ◽

Adrenal Vein Sampling

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Adrenal vein sampling: technique and protocol, a systematic review

CVIR Endovascular ◽

10.1186/s42155-021-00220-y ◽

2021 ◽

Vol 4 (1) ◽

Author(s):

Keith B. Quencer

Keyword(s):

Primary Aldosteronism ◽

Reliable Method ◽

Sampling Technique ◽

Secondary Hypertension ◽

Adrenal Vein ◽

Adrenal Vein Sampling ◽

Blood Pressure Elevation ◽

Aldosterone Production ◽

Procedural Success ◽

Work Up

AbstractPrimary aldosteronism is the leading cause of secondary hypertension worldwide. Its deleterious effects outstrip those due to blood pressure elevation alone. An essential part of the work-up of a patient with primary aldosteronism is determining if aldosterone production is unilateral or bilateral. With the former, surgery offers a potential cure and better overall outcomes. Adrenal vein sampling is considered the most reliable method to determine whether production is unilateral or bilateral. Sampling may be non-diagnostic when the vein cannot be properly cannulated. But with proper knowledge and experience as well as the utilization of certain techniques, procedure success can be high. Multiple protocols exist; their rationale and drawbacks are reviewed here. This article will give the reader an overview of techniques for improving procedural success as well as background, rationale and evidence to guide one in choosing the appropriate procedural and interpretation protocol.

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