title: Adrenal vein sampling using rapid cortisol assays in primary aldosteronism is useful in centers with low success rates.
abstract: OBJECTIVE
  Adrenal 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.
  
  
  METHODS
  We 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.
  
  
  METHODS
  Starting 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. Results During 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).
  
  
  CONCLUSIONS
  RCA during AVS are useful in centers with an initially low AVS success rate.
authors: Department of Medicine, University Hospital Innenstadt, Ludwig Maximilians University, Ziemssenstrasse 1, D-80336 Munich, Germany.
authors: Matthias J
authors: MJ
authors: Betz
authors: Christoph
authors: C
authors: Degenhart
authors: Evelyn
authors: E
authors: Fischer
authors: Anna
authors: A
authors: Pallauf
authors: Volker
authors: V
authors: Brand
authors: Ulrich
authors: U
authors: Linsenmaier
authors: Felix
authors: F
authors: Beuschlein
authors: Martin
authors: M
authors: Bidlingmaier
authors: Martin
authors: M
authors: Reincke