title: Adrenal Vein Sampling in Primary Aldosteronism: Sensitivity and Specificity of Basal Adrenal Vein to Peripheral Vein Cortisol and Aldosterone Ratios to Confirm Catheterization of the Adrenal Vein.
abstract: OBJECTIVE
  To assess the sensitivity and specificity for ratios of adrenal vein cortisol level (Ca) to peripheral vein cortisol level (Cp), adrenal vein aldosterone level (Aa) to peripheral vein aldosterone level (Ap), and combined cortisol and aldosterone levels ("combined ratio") for the detection of successful adrenal vein catheterization ("selectivity") in adrenal vein sampling (AVS) without adrenocorticotropic hormone (ACTH) injection at different cutoff values.
  
  
  METHODS
  This retrospective study was approved by the institutional review board, and informed consent was waived. AVS was performed in 160 consecutive patients (49 women and 111 men; mean age, 53.6 years) between December 1989 and January 2014. Cortisol and aldosterone levels were measured in samples from the adrenal veins and left iliac vein every 5 minutes, two times before (basal) and three times after intravenous cosyntropin (ACTH 1-24) injection. Selectivity was defined by Ca/Cp or Aa/Ap ratio of at least 5 in at least one sampling after ACTH administration. Sensitivity and specificity for the detection of selective adrenal vein catheterization were calculated for basal Ca/Cp ratio, Aa/Ap ratio, and combined ratios for three cutoff values reported in the literature. The McNemar test was used to assess differences in sensitivity and specificity to detect selective adrenal vein catheterization.
  
  
  RESULTS
  The sensitivity and specificity for the cutoff values of at least 3, at least 2, and at least 1.1 for the detection of AVS selectivity were respectively 50.4% and 100%, 70.8% and 100%, and 98.5% and 76.9% for Ca/Cp ratio; 61.3% and 100%, 70.8% and 100%, and 94.2% and 53.8% for Aa/Ap ratio; and 75.2% and 100%, 88.3% and 100%, and 99.3% and 46.2% for combined ratios (sensitivity at the ≥2 cutoff value: P < .0001 for combined ratio vs Ca/Cp ratio and for combined ratio vs Aa/Ap ratio).
  
  
  CONCLUSIONS
  Basal combined ratio has the best sensitivity for the detection of AVS selectivity at all cutoff values, and for all ratios, the cutoff value of at least 2 has the best sensitivity for 100% specificity.
authors.affiliation: From the Division of Interventional Radiology, Department of Radiology (J.P.M., M.T., G.S., M.F.G., P.G., V.L.O., E.T.), and Division of Endocrinology, Department of Medicine (P.S.Z., I.B., A.L.), Centre Hospitalier de l'Université de Montréal (CHUM), 3840 rue Saint-Urbain, Montréal, QC, Canada H2W 1T8; and Centre de Recherche du CHUM (CRCHUM), Montréal, QC, Canada (G.S., M.L.).
authors.forename: Jean-Philippe
authors.initials: JP
authors.lastname: Mailhot
authors.affiliation: From the Division of Interventional Radiology, Department of Radiology (J.P.M., M.T., G.S., M.F.G., P.G., V.L.O., E.T.), and Division of Endocrinology, Department of Medicine (P.S.Z., I.B., A.L.), Centre Hospitalier de l'Université de Montréal (CHUM), 3840 rue Saint-Urbain, Montréal, QC, Canada H2W 1T8; and Centre de Recherche du CHUM (CRCHUM), Montréal, QC, Canada (G.S., M.L.).
authors.forename: Manuela
authors.initials: M
authors.lastname: Traistaru
authors.affiliation: From the Division of Interventional Radiology, Department of Radiology (J.P.M., M.T., G.S., M.F.G., P.G., V.L.O., E.T.), and Division of Endocrinology, Department of Medicine (P.S.Z., I.B., A.L.), Centre Hospitalier de l'Université de Montréal (CHUM), 3840 rue Saint-Urbain, Montréal, QC, Canada H2W 1T8; and Centre de Recherche du CHUM (CRCHUM), Montréal, QC, Canada (G.S., M.L.).
authors.forename: Gilles
authors.initials: G
authors.lastname: Soulez
authors.affiliation: From the Division of Interventional Radiology, Department of Radiology (J.P.M., M.T., G.S., M.F.G., P.G., V.L.O., E.T.), and Division of Endocrinology, Department of Medicine (P.S.Z., I.B., A.L.), Centre Hospitalier de l'Université de Montréal (CHUM), 3840 rue Saint-Urbain, Montréal, QC, Canada H2W 1T8; and Centre de Recherche du CHUM (CRCHUM), Montréal, QC, Canada (G.S., M.L.).
authors.forename: Martin
authors.initials: M
authors.lastname: Ladouceur
authors.affiliation: From the Division of Interventional Radiology, Department of Radiology (J.P.M., M.T., G.S., M.F.G., P.G., V.L.O., E.T.), and Division of Endocrinology, Department of Medicine (P.S.Z., I.B., A.L.), Centre Hospitalier de l'Université de Montréal (CHUM), 3840 rue Saint-Urbain, Montréal, QC, Canada H2W 1T8; and Centre de Recherche du CHUM (CRCHUM), Montréal, QC, Canada (G.S., M.L.).
authors.forename: Marie-France
authors.initials: MF
authors.lastname: Giroux
authors.affiliation: From the Division of Interventional Radiology, Department of Radiology (J.P.M., M.T., G.S., M.F.G., P.G., V.L.O., E.T.), and Division of Endocrinology, Department of Medicine (P.S.Z., I.B., A.L.), Centre Hospitalier de l'Université de Montréal (CHUM), 3840 rue Saint-Urbain, Montréal, QC, Canada H2W 1T8; and Centre de Recherche du CHUM (CRCHUM), Montréal, QC, Canada (G.S., M.L.).
authors.forename: Patrick
authors.initials: P
authors.lastname: Gilbert
authors.affiliation: From the Division of Interventional Radiology, Department of Radiology (J.P.M., M.T., G.S., M.F.G., P.G., V.L.O., E.T.), and Division of Endocrinology, Department of Medicine (P.S.Z., I.B., A.L.), Centre Hospitalier de l'Université de Montréal (CHUM), 3840 rue Saint-Urbain, Montréal, QC, Canada H2W 1T8; and Centre de Recherche du CHUM (CRCHUM), Montréal, QC, Canada (G.S., M.L.).
authors.forename: Ping Shi
authors.initials: PS
authors.lastname: Zhu
authors.affiliation: From the Division of Interventional Radiology, Department of Radiology (J.P.M., M.T., G.S., M.F.G., P.G., V.L.O., E.T.), and Division of Endocrinology, Department of Medicine (P.S.Z., I.B., A.L.), Centre Hospitalier de l'Université de Montréal (CHUM), 3840 rue Saint-Urbain, Montréal, QC, Canada H2W 1T8; and Centre de Recherche du CHUM (CRCHUM), Montréal, QC, Canada (G.S., M.L.).
authors.forename: Isabelle
authors.initials: I
authors.lastname: Bourdeau
authors.affiliation: From the Division of Interventional Radiology, Department of Radiology (J.P.M., M.T., G.S., M.F.G., P.G., V.L.O., E.T.), and Division of Endocrinology, Department of Medicine (P.S.Z., I.B., A.L.), Centre Hospitalier de l'Université de Montréal (CHUM), 3840 rue Saint-Urbain, Montréal, QC, Canada H2W 1T8; and Centre de Recherche du CHUM (CRCHUM), Montréal, QC, Canada (G.S., M.L.).
authors.forename: Vincent L
authors.initials: VL
authors.lastname: Oliva
authors.affiliation: From the Division of Interventional Radiology, Department of Radiology (J.P.M., M.T., G.S., M.F.G., P.G., V.L.O., E.T.), and Division of Endocrinology, Department of Medicine (P.S.Z., I.B., A.L.), Centre Hospitalier de l'Université de Montréal (CHUM), 3840 rue Saint-Urbain, Montréal, QC, Canada H2W 1T8; and Centre de Recherche du CHUM (CRCHUM), Montréal, QC, Canada (G.S., M.L.).
authors.forename: André
authors.initials: A
authors.lastname: Lacroix
authors.affiliation: From the Division of Interventional Radiology, Department of Radiology (J.P.M., M.T., G.S., M.F.G., P.G., V.L.O., E.T.), and Division of Endocrinology, Department of Medicine (P.S.Z., I.B., A.L.), Centre Hospitalier de l'Université de Montréal (CHUM), 3840 rue Saint-Urbain, Montréal, QC, Canada H2W 1T8; and Centre de Recherche du CHUM (CRCHUM), Montréal, QC, Canada (G.S., M.L.).
authors.forename: Eric
authors.initials: E
authors.lastname: Therasse
mesh_terms: D000311:Adrenal Glands / Q000098:blood supply*; D000324:Adrenocorticotropic Hormone / Q000494:pharmacology; D000450:Aldosterone / Q000097:blood*; D002406:Catheterization, Peripheral / Q000379:methods*; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood*; D006929:Hyperaldosteronism / Q000097:blood*; D008297:Male; D008875:Middle Aged; D012680:Sensitivity and Specificity; D014680:Veins
chemical_list: D000450:Aldosterone; D000324:Adrenocorticotropic Hormone; D006854:Hydrocortisone