title: Role of adrenal vein sampling in primary aldosteronism: the Monash Health experience.
abstract: BACKGROUND
  Adrenal vein sampling (AVS) is useful for distinguishing unilateral versus bilateral hypersecretion in primary aldosteronism (PA), but is technically challenging. Furthermore, the use of adrenocorticotropic hormone (ACTH)-stimulation in AVS is controversial. We implemented a Monash Health-specific AVS protocol in 2010.
  
  
  OBJECTIVE
  The audit aimed to: (i) examine the impact of a dedicated protocol on success rates of AVS at a tertiary referral centre; (ii) evaluate the impact of AVS on sub-typing of PA; and (iii) assess the utility of ACTH stimulation in AVS.
  
  
  METHODS
  AVS was performed on patients with PA confirmed by positive saline suppression testing (aldosterone level >140 pmol/L post-saline infusion), with sequential sampling of adrenal and peripheral veins, pre- and post-ACTH infusion. Patients with unilateral aldosterone-producing adenoma diagnosed on successful AVS were referred for adrenalectomy.
  
  
  RESULTS
  Between 2010 and 2014 inclusive, a total of 28 AVS procedures was performed, with complete pre- and post-ACTH data for 19 procedures. Bilateral successful cannulation rates improved post-implementation of our protocol (61% vs 41%). Of the patients, 32% had discordant imaging and AVS results: four patients with unilateral adenomas did not lateralise on AVS and were managed medically; four patients with bilateral or no adenomas on imaging, lateralised on AVS and had surgery. Overall, use of ACTH did not increase successful cannulation and tended to mask lateralisation.
  
  
  CONCLUSIONS
  AVS is crucial in subtype classification of PA and should be performed by a dedicated radiologist with a standardised protocol. AVS outcomes were not improved with the use of ACTH stimulation.
authors.affiliation: Department of Endocrinology, Monash Medical Centre, Melbourne, Victoria, Australia.
authors.forename: J
authors.initials: J
authors.lastname: Teng
authors.affiliation: Department of Endocrinology, Monash Medical Centre, Melbourne, Victoria, Australia.
authors.forename: M E
authors.initials: ME
authors.lastname: Hutchinson
authors.affiliation: Monash Pathology, Monash Medical Centre, Melbourne, Victoria, Australia.|Department of Medicine, Monash University, Melbourne, Victoria, Australia.
authors.forename: J C G
authors.initials: JC
authors.lastname: Doery
authors.affiliation: Monash Pathology, Monash Medical Centre, Melbourne, Victoria, Australia.
authors.forename: K W
authors.initials: KW
authors.lastname: Choy
authors.affiliation: Monash Imaging, Monash Medical Centre, Melbourne, Victoria, Australia.
authors.forename: W
authors.initials: W
authors.lastname: Chong
authors.affiliation: Department of Endocrinology, Monash Medical Centre, Melbourne, Victoria, Australia.|Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Melbourne, Victoria, Australia.
authors.forename: P J
authors.initials: PJ
authors.lastname: Fuller
authors.affiliation: Department of Endocrinology, Monash Medical Centre, Melbourne, Victoria, Australia.|Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Melbourne, Victoria, Australia.
authors.forename: J
authors.initials: J
authors.lastname: Yang
mesh_terms: D000311:Adrenal Glands / Q000098:blood supply* / Q000187:drug effects / Q000378:metabolism*; D000324:Adrenocorticotropic Hormone / Q000008:administration & dosage; D000328:Adult; D000368:Aged; D000450:Aldosterone / Q000097:blood / Q000378:metabolism; D001315:Australia / Q000453:epidemiology; D003695:Delivery of Health Care / Q000379:methods*; D005260:Female; D006801:Humans; D006929:Hyperaldosteronism / Q000097:blood* / Q000175:diagnosis* / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D014680:Veins / Q000187:drug effects / Q000378:metabolism
chemical_list: D000450:Aldosterone; D000324:Adrenocorticotropic Hormone
keywords: adrenal vein sampling; endocrine hypertension; primary aldosteronism