Efficacy of adrenal venous sampling is increased by point of care cortisol analysis (original) (raw)
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European Journal of Endocrinology, 2011
Objective: Adrenal vein sampling (AVS) is considered the gold standard in the differential diagnosis of primary aldosteronism (PA), but success rates vary between centers. We hypothesized that rapid (intraprocedure) cortisol measurement can improve performance in a center with initially low AVS success rate. Design: We analyzed 46 patients with confirmed PA studied between 2008 and 2010. Forty-seven PA patients studied between 2004 and 2008 identified by retrospective chart review served as controls. All patients were treated at a single tertiary care university hospital. Methods: Starting in 2008, rapid cortisol assays (RCA) were performed in all patients during the AVS procedure. A cortisol gradient of R2.0 between adrenal vein and a femoral vein sample was used as success criterion. Up to two repeat samples were drawn if adrenal vein cortisol was below this threshold. Results: During the control period 26 of 47 AVS were successful (55%). After introduction of RCA, 39 out of 46 AVS (85%) were successful (PZ0.003). In 21 of the 46 cases (46%) a resampling was necessary. The increase in overall success was due to an increase in successful right AVS (85 vs 62% before introduction of RCA; PZ0.02) and a training effect (PZ0.024 for trend). Conclusion: RCA during AVS are useful in centers with an initially low AVS success rate.
European Journal of Endocrinology, 2010
Objective: In primary aldosteronism, adrenal venous sampling (AVS) is essential for subtype differentiation as it evaluates aldosterone secretion from both adrenals. Selectivity of adrenal sampling is assessed by the ratio of cortisol concentrations in adrenal venous blood and inferior vena cava blood (C adrenal /C ivc ). Since the criteria for selective adrenal sampling differ among the reported literature, we performed a study to evaluate the influence of different selectivity criteria on AVS results. Design and methods: Reports of AVS were screened retrospectively. All AVS were performed with cosyntrophin infusion. Reports containing samples with C adrenal /C ivc R10 taken from both adrenals and at least one other adrenal sample characterised by C adrenal /C ivc R1.1 were enrolled. For each individual, we chose reference samples that were defined by the highest C adrenal /C ivc achieved from each adrenal. The significance of the remaining samples with C adrenal /C ivc R1.1 was analysed in regard to their respective reference samples. We assessed the impact of analysed samples on identification of lateralisation of aldosterone secretion that is crucial for decisions concerning adrenalectomy. Results: AVS reports of 87 patients were enrolled. A total of 225 adrenal samples were analysed and divided into five groups according to C adrenal /C ivc :1.1-1.99, 2-2.99, 3-4.99, 5-9.99 and R10. By comparing reference with analysed samples, a concordant assessment with respect to lateralisation of aldosterone secretion was observed in 39, 52, 72, 85 and 94% of the respective groups of analysed samples.
Update: Selective adrenal venous sampling (AVS) – Indication, technique, and significance
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Background Primary aldosteronism (PA) is the most common detectable cause of secondary hypertension. The majority of patients have either an adrenal aldosterone-producing adenoma (APA) or bilateral adrenal hyperplasia (BAH) demanding different therapeutic approaches. Screening tests and imaging cannot reliably distinguish between a unilateral or bilateral PA. Methods This review article gives an overview concerning etiology, diagnostics, and therapeutic options of PA, and reviews the indication, the technique, and relevance of selective adrenal venous sampling (AVS) in the context of the current literature and the authors’ experience. Results AVS can verify or exclude a unilaterally dominated secretion with a high success rate. Patients with PA and a unilateral APA can be treated curatively by adrenalectomy. Conclusions AVS is an established diagnostic examination for differentiation of unilateral from bilateral adrenal disease in patients with PA. Key Points: Citation Format
2015
Objective: Many investigators believe basal adrenal venous sampling (AVS) should be done simultaneously while others opt for sequential AVS for simplicity and reduced cost. This study aimed to evaluate concordance of sequential and simultaneous AVS methods. Design and methods: Between 1989 and 2015, bilateral simultaneous sets of basal AVS were obtained twice within 5 minutes, 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 were simulated by using right sampling at-5 minutes (t=-5) and left sampling at 0 minute (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 (
Adrenal vein sampling in primary aldosteronism: concordance of simultaneous vs sequential sampling
European Journal of Endocrinology, 2016
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. Design and 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....
Adrenal Venous Sampling: Evaluation of the German Conn's Registry
Hypertension, 2011
In patients with primary aldosteronism, adrenal venous sampling is helpful to distinguish between unilateral and bilateral adrenal diseases. However, the procedure is technically challenging, and selective bilateral catheterization often fails. The aim of this analysis was to evaluate success rate in a retrospective analysis and compare data with procedures done prospectively after introduction of measures designed to improve rates of successful cannulation. Patients were derived from a cross-sectional study involving 5 German centers (German Conn's registry). In the retrospective phase, 569 patients with primary aldosteronism were registered between 1990 and 2007, of whom 230 received adrenal venous sampling. In 200 patients there were sufficient data to evaluate the procedure. In 2008 and 2009, primary aldosteronism was diagnosed in 156 patients, and adrenal venous sampling was done in 106 and evaluated prospectively. Retrospective evaluation revealed that 31% were bilaterally selective when a selectivity index (cortisol adrenal vein/cortisol inferior vena cava) of Ն2.0 was applied. Centers completing Ͻ20 procedures had success rates between 8% and 10%. Overall success rate increased in the prospective phase from 31% to 61%. Retrospective data demonstrated the pitfalls of performing adrenal venous sampling. Even in specialized centers, success rates were poor. Marked improvements could be observed in the prospective phase. Selected centers that implemented specific measures to increase accuracy, such as rapid-cortisol-assay and introduction of standard operating procedures, reached success rates of Ͼ70%. These data demonstrate the importance of throughput, expertise, and various potentially beneficial measures to improve adrenal vein sampling. (Hypertension. 2011;57:990-995.) Key Words: primary aldosteronism Ⅲ adrenal vein sampling Ⅲ aldosterone-producing adenoma Ⅲ bilateral idiopathic hyperaldosteronism Ⅲ rapid cortisol assay
Journal of Vascular and Interventional Radiology, 2011
Purpose: Adrenal venous sampling (AVS) is limited by technical failures that result from incorrect catheter placement or failure to catheterize the right adrenal vein. The existence of an inadequate sample may not be recognized at the time of the procedure, which can lead to nondiagnostic results. Rapid assay of serum cortisol levels allows for intraprocedural evaluation of the ratio of adrenal and peripheral cortisol concentrations and confirmation of adequate sampling.
Kardiologia Polska, 2017
Background: Primary aldosteronism is one of the most common causes of secondary hypertension. Adrenal vein sampling (AVS) remains a "gold standard" procedure in differentiation between unilateral (adenoma) and bilateral (hyperplasia) disease. Aim: The aim of this study was to present our single-centre experience in establishing and implementating the AVS procedure. Methods: All patients had primary aldosteronism confirmed in a salt-infusion test. AVS was performed sequentially during a continuous intravenous infusion of cosyntropin and was preceded by multislice contrast-enhanced computed tomography (CT) examination of adrenal glands performed a few weeks before AVS in the majority of patients. AVS was regarded as successful if the ratio of each adrenal vein cortisol to inferior vena cava cortisol levels (selectivity index [SI]) was higher than 3.0. In the case of failure, a second attempt was considered in a few weeks. Patients were divided into four groups according to the order of the procedure by quartiles. Results: Between 31 May, 2012 and 5 May, 2016, AVS was performed in 124 patients (69% males, aged 55.3 ± 10.3 years) and was successful in 120 (96.8%) patients. All failed cases were due to the failure of cannulation of the right adrenal vein. The first-attempt success rate was 94.3% (117 of 124 patients) and increased from 83.9% in the first 31 patients to 100% in the last 31 patients. Similarly, the overall success rate increased from 93.5% to 100%. The right SI was significantly higher than the left one (26.4 vs. 11.0, p < 0.0001). Both indices did not differ across quartiles of patients. No complications occurred during the procedure. Conclusions: The AVS procedure, preceded by adrenal CT, may be implemented into daily diagnostic practice safely with an excellent success rate.