title: Impact of different diagnostic criteria during adrenal vein sampling on reproducibility of subtype diagnosis in patients with primary aldosteronism.
abstract: In patients with primary aldosteronism, adrenal vein sampling (AVS) is considered the only reliable technique to distinguish between unilateral and bilateral autonomous production of aldosterone, but agreement is lacking on the best criteria indicating successful cannulation and lateralization. The objective of this study was to assess the impact of differing criteria for the successful cannulation and lateralization on the reproducibility of subtype diagnosis. Sixty-two patients with confirmed primary aldosteronism underwent AVS on 2 separate occasions, because the first was unsatisfactory. We compared the different diagnoses of primary aldosteronism subtype reached using AVS data assessed by permissive (type 1), intermediate (type 2), and strict (type 3) criteria. Although 91.1% of all of the (both first and second) AVSs were "successful" by type 1 criteria (50.8% by type 2 and 33.9% by type 3), in only 35.3% of patients was the diagnosis concordant between the first and second AVS. Type 1 criteria also led to a higher rate of diagnosis of unilateral primary aldosteronism (67.3% of successful procedures) than type 2 (36.5%) or type 3 (26.2%). There was considerable disparity in the diagnosis reached using the 3 different criteria, with concordance in only 32.2%. Using either type 1 or 2 criteria, the minimal adrenal/peripheral vein cortisol ratio necessary to obtain the same diagnosis in the first and second AVS procedures was >/=2.75. In conclusion, permissive criteria for successful cannulation and lateralization on AVS achieve poor diagnostic reproducibility and should be avoided.
authors.affiliation: Department of Medicine and Experimental Oncology, University of Torino, Torino, Italy. paolo.mulatero@libero.it
authors.forename: Paolo
authors.initials: P
authors.lastname: Mulatero
authors.forename: Chiara
authors.initials: C
authors.lastname: Bertello
authors.forename: Norlela
authors.initials: N
authors.lastname: Sukor
authors.forename: Richard
authors.initials: R
authors.lastname: Gordon
authors.forename: Denis
authors.initials: D
authors.lastname: Rossato
authors.forename: Nicholas
authors.initials: N
authors.lastname: Daunt
authors.forename: David
authors.initials: D
authors.lastname: Leggett
authors.forename: Giulio
authors.initials: G
authors.lastname: Mengozzi
authors.forename: Franco
authors.initials: F
authors.lastname: Veglio
authors.forename: Michael
authors.initials: M
authors.lastname: Stowasser
mesh_terms: D000236:Adenoma / Q000097:blood / Q000175:diagnosis; D000310:Adrenal Gland Neoplasms / Q000097:blood / Q000150:complications / Q000175:diagnosis; D000311:Adrenal Glands / Q000098:blood supply*; D000312:Adrenal Hyperplasia, Congenital / Q000097:blood / Q000150:complications / Q000175:diagnosis; D000450:Aldosterone / Q000097:blood*; D002404:Catheterization / Q000592:standards; D003935:Diagnostic Techniques, Cardiovascular / Q000592:standards*; D003940:Diagnostic Techniques, Endocrine / Q000592:standards*; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D006929:Hyperaldosteronism / Q000097:blood / Q000175:diagnosis* / Q000209:etiology; D006973:Hypertension / Q000097:blood / Q000175:diagnosis* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D014680:Veins
chemical_list: D000450:Aldosterone; D006854:Hydrocortisone