Rapid cortisol assays improve the success rate of adrenal vein sampling for primary aldosteronism.
OBJECTIVE
We hypothesized that an adrenal vein sampling (AVS) algorithm incorporating rapid cortisol assays, which enables resampling of the adrenal veins, would improve the success rate by a team of radiologists.


BACKGROUND
AVS is the most accurate means to localize aldosterone production in primary aldosteronism (PA). However, cannulation of the right adrenal vein (RAV) is difficult, and success is assumed from venography without the support of steroid assays. Furthermore, few institutions can assign all studies to 1 dedicated and experienced AVS interventional radiologist.


METHODS
Retrospective chart review of patients with PA at our university hospitals who underwent AVS. We compared results for 30 AVS studies incorporating rapid cortisol assays with 30 conventional AVS studies.


RESULTS
The success rate for the control period was 73% (22/30 studies). For the first 30 studies after incorporating rapid cortisol assay, the success rate increased to 97% (29/30 studies). Resampling the RAV was required for 2 studies, and prolonged sheath insertion did not cause any complications.


CONCLUSIONS
High AVS success rates may be achieved by a team of interventional radiologists at 1 center using defined AVS protocols. Rapid cortisol assay allows for resampling of the RAV and improves AVS success rates.
Auchus
Richard J
RJ
Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas 75390-8857, USA. richard.auchus@UTSouthwestern.edu
Michaelis
Christina
C
Wians
Frank H
FH
Dolmatch
Bart L
BL
Josephs
Shellie C
SC
Trimmer
Clayton K
CK
Anderson
Matthew E
ME
Nwariaku
Fiemu E
FE
D000311:Adrenal Glands / Q000098:blood supply*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood*; D006929:Hyperaldosteronism / Q000097:blood* / Q000175:diagnosis* / Q000601:surgery; D007118:Immunoassay; D008297:Male; D008875:Middle Aged; D010690:Phlebography; D012189:Retrospective Studies; D013997:Time Factors; D014680:Veins
D006854:Hydrocortisone