Adrenal vein sampling in primary aldosteronism: concordance of simultaneous vs sequential sampling.
OBJECTIVE
Many investigators believe that basal adrenal venous sampling (AVS) should be done simultaneously, whereas others opt for sequential AVS for simplicity and reduced cost. This study aimed to evaluate the concordance of sequential and simultaneous AVS methods.


METHODS
Between 1989 and 2015, bilateral simultaneous sets of basal AVS were obtained twice within 5 min, in 188 consecutive patients (59 women and 129 men; mean age: 53.4 years). Selectivity was defined by adrenal-to-peripheral cortisol ratio ≥2, and lateralization was defined as an adrenal aldosterone-to-cortisol ratio ≥2, the contralateral side. Sequential AVS was simulated using right sampling at -5 min (t = -5) and left sampling at 0 min (t = 0).


RESULTS
There was no significant difference in mean selectivity ratio (P = 0.12 and P = 0.42 for the right and left sides respectively) and in mean lateralization ratio (P = 0.93) between t = -5 and t = 0. Kappa for selectivity between 2 simultaneous AVS was 0.71 (95% CI: 0.60-0.82), whereas it was 0.84 (95% CI: 0.76-0.92) and 0.85 (95% CI: 0.77-0.93) between sequential and simultaneous AVS at respectively -5 min and at 0 min. Kappa for lateralization between 2 simultaneous AVS was 0.84 (95% CI: 0.75-0.93), whereas it was 0.86 (95% CI: 0.78-0.94) and 0.80 (95% CI: 0.71-0.90) between sequential AVS and simultaneous AVS at respectively -5 min at 0 min.


CONCLUSIONS
Concordance between simultaneous and sequential AVS was not different than that between 2 repeated simultaneous AVS in the same patient. Therefore, a better diagnostic performance is not a good argument to select the AVS method.
Department of RadiologyCentre Hospitalier de l'Université de Montréal (CHUM), Montréal, Quebec, Canada.
Mohamed-Karji
MK
Almarzooqi
Department of Mathematics and StatisticsUniversity of Montreal, Montréal, Quebec, Canada.
Miguel
M
Chagnon
Department of RadiologyCentre Hospitalier de l'Université de Montréal (CHUM), Montréal, Quebec, Canada.|Centre de RechercheCHUM (CRCHUM), Montréal, Quebec, Canada.
Gilles
G
Soulez
Department of RadiologyCentre Hospitalier de l'Université de Montréal (CHUM), Montréal, Quebec, Canada.
Marie-France
MF
Giroux
Department of RadiologyCentre Hospitalier de l'Université de Montréal (CHUM), Montréal, Quebec, Canada.
Patrick
P
Gilbert
Department of RadiologyCentre Hospitalier de l'Université de Montréal (CHUM), Montréal, Quebec, Canada.
Vincent L
VL
Oliva
Department of RadiologyCentre Hospitalier de l'Université de Montréal (CHUM), Montréal, Quebec, Canada.
Pierre
P
Perreault
Department of RadiologyCentre Hospitalier de l'Université de Montréal (CHUM), Montréal, Quebec, Canada.
Louis
L
Bouchard
Department of MedicineDivision of Endocrinology, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Quebec, Canada.
Isabelle
I
Bourdeau
Department of MedicineDivision of Endocrinology, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Quebec, Canada.
André
A
Lacroix
Department of RadiologyCentre Hospitalier de l'Université de Montréal (CHUM), Montréal, Quebec, Canada eric.therasse.chum@ssss.gouv.qc.ca.
Eric
E
Therasse
D000311:Adrenal Glands / Q000098:blood supply*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000450:Aldosterone / Q000378:metabolism; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000378:metabolism; D006929:Hyperaldosteronism / Q000378:metabolism*; D007084:Iliac Vein; D008297:Male; D008875:Middle Aged; D055815:Young Adult
D000450:Aldosterone; D006854:Hydrocortisone