title: Intraprocedural cortisol measurement increases adrenal vein sampling success rate in primary aldosteronism.
abstract: BACKGROUND
  Adrenal venous sampling (AVS) is the gold standard for the identification of unilateral primary aldosteronism (PA), but is technically difficult. The aim of our study was to assess whether intraprocedural cortisol measurement (IPCM) increases AVS success rate.
  
  
  METHODS
  Twenty-five consecutive PA patients underwent cosyntropin-stimulated AVS. Cortisol was measured immediately in a first set of samples drawn from adrenal veins and inferior vena cava. The selectivity criterion was an adrenal vein-to-inferior vena cava cortisol ratio ≥5. If bilateral selectivity was not achieved in a first set of samples, a second set was obtained during the same radiological session. PA was judged as unilateral if the gradient of cortisol-corrected aldosterone between dominant and nondominant side was >3.5. Twenty-five consecutive PA patients who had previously been submitted to AVS without IPCM served as historical controls. Lateralizing patients who underwent unilateral adrenalectomy were followed for 2 years after surgery.
  
  
  RESULTS
  Bilateral selectivity using IPCM was achieved in 19/25 patients in the first set of samples, and in an additional four cases in the second set (92% vs. 76%; P = 0.06). The final rate of bilateral selectivity was higher than that obtained in the historical series (23/25 vs. 16/25, P = 0.04), whereas bilateral selectivity in the first set of samples was not different from that achieved in the historical series. Nineteen lateralizing patients (13 of the present series, six of the historical series) were submitted to adrenalectomy, resulting in reversal of PA.
  
  
  CONCLUSIONS
  IPCM increases the success rate of AVS.
authors.affiliation: Second Unit of Internal Medicine, Department of Internal Medicine, Santa Maria Nuova Hospital, Reggio Emilia, Italy.
authors.forename: Ermanno
authors.initials: E
authors.lastname: Rossi
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Regolisti
authors.forename: Franco
authors.initials: F
authors.lastname: Perazzoli
authors.forename: Aurelio
authors.initials: A
authors.lastname: Negro
authors.forename: Chiara
authors.initials: C
authors.lastname: Grasselli
authors.forename: Rosaria
authors.initials: R
authors.lastname: Santi
authors.forename: Simonetta
authors.initials: S
authors.lastname: Cavalieri
authors.forename: Lucia
authors.initials: L
authors.lastname: Belloni
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Gemelli
authors.forename: Edoardo
authors.initials: E
authors.lastname: Della Valle
authors.forename: Diego
authors.initials: D
authors.lastname: Miotto
mesh_terms: D000311:Adrenal Glands / Q000098:blood supply / Q000000981:diagnostic imaging / Q000601:surgery; D000450:Aldosterone / Q000097:blood; D000803:Angiotensin I / Q000097:blood; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood*; D006929:Hyperaldosteronism / Q000097:blood* / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010690:Phlebography; D012083:Renin / Q000097:blood; D014682:Vena Cava, Inferior / Q000000981:diagnostic imaging
chemical_list: D000450:Aldosterone; D000803:Angiotensin I; D012083:Renin; D006854:Hydrocortisone