title: Diagnostic utility of data from adrenal venous sampling for primary aldosteronism despite failed cannulation of the right adrenal vein.
abstract: BACKGROUND
  Adrenal venous sampling is an important lateralization study for primary aldosteronism, but inability to cannulate the right adrenal vein is not uncommon and interpreted as a failed study. We challenged this notion by examining whether data from incomplete left-sided adrenal venous sampling could accurately predict lateralization.
  
  
  METHODS
  Sixty-two adrenal venous sampling studies from 2007 to 2014 at 2 tertiary-care institutions were reviewed. For this analysis, data from the right adrenal vein were excluded. The study variable was the aldosterone:cortisol ratio of the left adrenal vein compared with the inferior vena cava (LAV/IVC). Scatterplot analysis identified high and low LAV/IVC cutoffs that predicted accurately unilateral disease in 1 institutional cohort and validated in the second cohort.
  
  
  RESULTS
  Thirty-six studies of adrenal venous sampling were evaluated at the first institution and divided into 3 diagnostic categories: unilateral-left (n = 14), unilateral-right (n = 12), and bilateral (n = 10). Cutoff values of the ratios of LAV/IVC of ≥ 5.5 and ≤ 0.5 accurately predicted left- and right-sided disease, respectively, and were validated in 26 studies from the second institution (100% PPV). The "5.5-0.5 criteria" salvaged accuracy for predicting lateralization in 50% of cases.
  
  
  CONCLUSIONS
  Even in the setting of failed cannulation of the right adrenal vein, the actual data from the remaining adrenal venous sampling can predict lateralization accurately in many patients. A "failed" adrenal venous sampling study may be of greater predictive utility than believed traditionally.
authors.affiliation: Endocrine Surgery Section, Department of Surgery, University of California, San Francisco, CA.
authors.forename: Jesse D
authors.initials: JD
authors.lastname: Pasternak
authors.affiliation: Endocrine Surgery Section, Department of Surgery, Columbia University, New York, NY.
authors.forename: Irene
authors.initials: I
authors.lastname: Epelboym
authors.affiliation: Endocrine Surgery Section, Department of Surgery, University of California, San Francisco, CA.
authors.forename: Natalie
authors.initials: N
authors.lastname: Seiser
authors.affiliation: Endocrine Surgery Section, Department of Surgery, Columbia University, New York, NY.
authors.forename: Matt
authors.initials: M
authors.lastname: Wingo
authors.affiliation: Endocrine Surgery Section, Department of Surgery, Columbia University, New York, NY.
authors.forename: Max
authors.initials: M
authors.lastname: Herman
authors.affiliation: Endocrine Surgery Section, Department of Surgery, Columbia University, New York, NY.
authors.forename: Vanessa
authors.initials: V
authors.lastname: Cowan
authors.affiliation: Endocrine Surgery Section, Department of Surgery, University of California, San Francisco, CA.
authors.forename: Jessica E
authors.initials: JE
authors.lastname: Gosnell
authors.affiliation: Endocrine Surgery Section, Department of Surgery, University of California, San Francisco, CA.
authors.forename: Wen T
authors.initials: WT
authors.lastname: Shen
authors.affiliation: Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA.
authors.forename: Robert K
authors.initials: RK
authors.lastname: Kerlan
authors.affiliation: Endocrine Surgery Section, Department of Surgery, Columbia University, New York, NY.
authors.forename: James A
authors.initials: JA
authors.lastname: Lee
authors.affiliation: Endocrine Surgery Section, Department of Surgery, University of California, San Francisco, CA.
authors.forename: Quan-Yang
authors.initials: QY
authors.lastname: Duh
authors.affiliation: Endocrine Surgery Section, Department of Surgery, University of California, San Francisco, CA. Electronic address: Insoo.suh@ucsf.edu.
authors.forename: Insoo
authors.initials: I
authors.lastname: Suh
mesh_terms: D000311:Adrenal Glands / Q000098:blood supply*; D000328:Adult; D000368:Aged; D000450:Aldosterone / Q000097:blood*; D002404:Catheterization; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood*; D006929:Hyperaldosteronism / Q000097:blood* / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D012082:Renal Veins; D012189:Retrospective Studies; D014682:Vena Cava, Inferior
chemical_list: D000450:Aldosterone; D006854:Hydrocortisone