Adrenal vein sampling in primary aldosteronism: towards a standardised protocol.
Primary aldosteronism comprises subtypes that need different therapeutic strategies. Adrenal vein sampling is recognised by Endocrine Society guidelines as the only reliable way to correctly diagnose the subtype of primary aldosteronism. Unfortunately, despite being the gold-standard procedure, no standardised procedure exists either in terms of performance or interpretation criteria. In this Personal View, we address several questions that clinicians are presented with when considering adrenal vein sampling. For each of these questions we provide responses based on the available evidence, and opinions based on our experience. In particular, we discuss the most appropriate way to prepare the patient, whether adrenal vein sampling can be avoided for some subgroups of patients, the use of ACTH (1-24) during the procedure, the most appropriate criteria for interpretation of adrenal vein cannulation and lateralisation, the use of contralateral suppression, and strategies to improve success rates of adrenal vein sampling in centres with little experience.
Department of Medical Sciences, Division of Internal Medicine and Hypertension Unit, University of Torino, Torino, Italy.
Silvia
S
Monticone
Department of Medical Sciences, Division of Internal Medicine and Hypertension Unit, University of Torino, Torino, Italy.
Andrea
A
Viola
Service of Radiology, University of Torino, Torino, Italy.
Denis
D
Rossato
Department of Medical Sciences, Division of Internal Medicine and Hypertension Unit, University of Torino, Torino, Italy.
Franco
F
Veglio
Medizinische Klinik und Poliklinik IV, Campus Innenstadt, Ludwig Maximilians University Hospital, Munich, Germany.
Martin
M
Reincke
Division of Endocrinology, G.V. (Sonny) Montgomery VA Medical Center and University of Mississippi Medical Center, Jackson, MS, USA.
Celso
C
Gomez-Sanchez
Department of Medical Sciences, Division of Internal Medicine and Hypertension Unit, University of Torino, Torino, Italy. Electronic address: paolo.mulatero@unito.it.
Paolo
P
Mulatero
D000306:Adrenal Cortex Neoplasms / Q000097:blood* / Q000175:diagnosis; D000311:Adrenal Glands / Q000098:blood supply*; D018246:Adrenocortical Adenoma / Q000097:blood* / Q000175:diagnosis; D002406:Catheterization, Peripheral / Q000379:methods*; D002985:Clinical Protocols; D006801:Humans; D006929:Hyperaldosteronism / Q000097:blood* / Q000175:diagnosis; D018962:Phlebotomy / Q000379:methods*