Adrenal vein sampling using rapid cortisol assays in primary aldosteronism is useful in centers with low success rates

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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Repeat adrenal vein sampling in aldosteronism: reproducibility and interpretation of persistently discordant results

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/clinem/dgaa930 ◽

2020 ◽

Author(s):

Gregory A Kline ◽

Alexander Ah-Chi Leung ◽

Davis Sam ◽

Alex Chin ◽

Benny So

Keyword(s):

Care Center ◽

Tertiary Care ◽

Retrospective Chart Review ◽

Final Diagnosis ◽

Adrenal Vein ◽

Secondary Outcome ◽

Secondary Outcome Measure ◽

Moderate Correlation ◽

Initial Attempt ◽

Adrenal Vein Sampling

Abstract Context The reproducibility of adrenal vein sampling(AVS) is unknown. Objective Determine reproducibility of biochemical results and diagnostic lateralization in patients undergoing repeat AVS. Design Retrospective chart review of single-center, single-operator AVS procedures. Setting Tertiary care center. Patients Patients with confirmed PA undergoing repeat AVS due to concerns about technical success or discordant diagnostic results. Intervention Simultaneous AVS by an experienced operator using a consistent protocol of both pre-and post-cosyntropin infusion. Main Outcome Measures Among successfully catheterized adrenal veins(selectivity index ≥ 2) the correlation of the adrenalaldosterone/cortisol ratio between the first and second AVS. Secondary outcome measure was diagnostic agreement in repeat AVS lateralization(lateralization index ≥ 3). Results There were 46 sets of AVS from 23 patients, median 3 months apart. There was moderate correlation in aldosterone/cortisol ratios in adrenal veins and IVC(Spearman r = 0.49-0.59, p<0.05) pre-cosyntropin. Post-cosyntropin, the correlation was better(Spearman r=0.67-0.76, p<0.05). In technically successful AVS, there was moderate correlation between the repeated lateralization indices(Spearman r=0.53, p<0.05). In 15 patients where repeat AVS was done due to apparent lateralization discordance with CT imaging, the final diagnosis was the same in the second AVS procedure. Initial failed AVS was successful 75% of the time upon repeat attempt. Conclusions Repeat AVS was feasible and usually successful when an initial attempt failed. There was modest correlation between individual repeat adrenal aldosterone/cortisol ratios and lateralization indices when AVS was done twice. Final lateralization diagnosis was identical in all cases. This demonstrates that AVS is a reliable and reproducible localizing test in PA.

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

American Journal of Hypertension ◽

10.1038/ajh.2011.148 ◽

2011 ◽

Vol 24 (12) ◽

pp. 1280-1285 ◽

Cited By ~ 24

Author(s):

E. Rossi ◽

G. Regolisti ◽

F. Perazzoli ◽

A. Negro ◽

C. Grasselli ◽

...

Keyword(s):

Success Rate ◽

Primary Aldosteronism ◽

Adrenal Vein ◽

Adrenal Vein Sampling

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Improved technical success and radiation safety of adrenal vein sampling using rapid, semi-quantitative point-of-care cortisol measurement

Annals of Clinical Biochemistry International Journal of Laboratory Medicine ◽

10.1177/0004563218760352 ◽

2018 ◽

Vol 55 (5) ◽

pp. 588-592 ◽

Cited By ~ 3

Author(s):

Michael M Page ◽

Mario Taranto ◽

Duncan Ramsay ◽

Greg van Schie ◽

Paul Glendenning ◽

...

Keyword(s):

Success Rate ◽

Point Of Care ◽

Adrenal Vein ◽

Success Rates ◽

Technical Success ◽

Adrenal Vein Sampling ◽

Measuring Device ◽

Sampling Studies ◽

Technical Success Rate ◽

Sampling Procedures

Objective Primary aldosteronism is a curable cause of hypertension which can be treated surgically or medically depending on the findings of adrenal vein sampling studies. Adrenal vein sampling studies are technically demanding with a high failure rate in many centres. The use of intraprocedural cortisol measurement could improve the success rates of adrenal vein sampling but may be impracticable due to cost and effects on procedural duration. Design Retrospective review of the results of adrenal vein sampling procedures since commencement of point-of-care cortisol measurement using a novel single-use semi-quantitative measuring device for cortisol, the adrenal vein sampling Accuracy Kit. Measurements: Success rate and complications of adrenal vein sampling procedures before and after use of the adrenal vein sampling Accuracy Kit. Routine use of the adrenal vein sampling Accuracy Kit device for intraprocedural measurement of cortisol commenced in 2016. Results Technical success rate of adrenal vein sampling increased from 63% of 99 procedures to 90% of 48 procedures ( P = 0.0007) after implementation of the adrenal vein sampling Accuracy Kit. Failure of right adrenal vein cannulation was the main reason for an unsuccessful study. Radiation dose decreased from 34.2 Gy.cm2 (interquartile range, 15.8–85.9) to 15.7 Gy.cm2 (6.9–47.3) ( P = 0.009). No complications were noted, and implementation costs were minimal. Conclusions Point-of-care cortisol measurement during adrenal vein sampling improved cannulation success rates and reduced radiation exposure. The use of the adrenal vein sampling Accuracy Kit is now standard practice at our centre.

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