title: Adrenal Vein Sampling for Conn's Syndrome: Diagnosis and Clinical Outcomes.
abstract: Adrenal vein sampling (AVS) is the gold standard test to determine unilateral causes of primary aldosteronism (PA). We have retrospectively characterized our experience with AVS including concordance of AVS results and imaging, and describe the approach for the PA patient in whom bilateral AVS is unsuccessful. We reviewed the medical records of 85 patients with PA and compared patients who were treated medically and surgically on pre-procedure presentation and post-treatment outcomes, and evaluated how technically unsuccessful AVS results were used in further patient management. Out of the 92 AVS performed in 85 patients, AVS was technically successful bilaterally in 58 (63%) of cases. Either unsuccessful AVS prompted a repeat AVS, or results from the contralateral side and from CT imaging were used to guide further therapy. Patients who were managed surgically with adrenalectomy had higher initial blood pressure and lower potassium levels compared with patients who were managed medically. Adrenalectomy results in significantly decreased blood pressure and normalization of potassium levels. AVS can identify surgically curable causes of PA, but can be technically challenging. When one adrenal vein fails to be cannulated, results from the contralateral vein can be useful in conjunction with imaging and clinical findings to suggest further management.
authors: Division of Vascular & Interventional Radiology, Department of Radiology, New York University Medical Center, New York, NY 10016, USA. amy.deipolyi@nyumc.org.
authors: Amy R
authors: AR
authors: Deipolyi
authors: Massachusetts General Hospital, Harvard Medical School, Division of Interventional Radiology, 55 Fruit Street, GRB-290A, Boston, MA 02114, USA. bhartealex@gmail.com.
authors: Alexander
authors: A
authors: Bailin
authors: Massachusetts General Hospital, Harvard Medical School, Division of Interventional Radiology, 55 Fruit Street, GRB-290A, Boston, MA 02114, USA. stephan.wickyvandoyer@umassmemorial.org.
authors: Stephan
authors: S
authors: Wicky
authors: Massachusetts General Hospital, Harvard Medical School, Division of Interventional Radiology, 55 Fruit Street, GRB-290A, Boston, MA 02114, USA. drshehabalansari@gmail.com.
authors: Shehab
authors: S
authors: Alansari
authors: Massachusetts General Hospital, Harvard Medical School, Division of Interventional Radiology, 55 Fruit Street, GRB-290A, Boston, MA 02114, USA. roklu@mgh.harvard.edu.
authors: Rahmi
authors: R
authors: Oklu
keywords: Conn’s syndrome; adrenal vein sampling; endocrinology; primary aldosteronism