<abstract xmlns="http://www.w3.org/1999/xhtml"><sec id="j_raon-2020-0052_s_006_w2aab3b7d146b1b6b1aab1c16b1Aa"><h3>Background</h3><p>Adrenal vein sampling (AVS) is essential for diagnostics of primary aldosteronism, distinguishing unilateral from bilateral disease and determining treatment options. We reviewed the performance of AVS for primary aldosteronism at our center during first 15 years, comparing the initial period to the period after the introduction of a dedicated radiologist. Additionally, AVS outcomes were checked against CT findings and the proportion of operated patients with proven unilateral disease was estimated.</p></sec><sec id="j_raon-2020-0052_s_007_w2aab3b7d146b1b6b1aab1c16b2Aa"><h3>Patients and methods</h3><p>A retrospective cross-sectional study conducted at the national endocrine referral center included all patients with primary aldosteronism who underwent AVS after its introduction in 2004 until the end of 2018. AVS was performed sequentially during Synacthen infusion. When the ratio of cortisol concentrations from adrenal vein and inferior vena cava was at least 5, AVS was considered successful.</p></sec><sec id="j_raon-2020-0052_s_008_w2aab3b7d146b1b6b1aab1c16b3Aa"><h3>Results</h3><p>Data from 235 patients were examined (168 men; age 32–73, median 56 years; BMI 18–48, median 30.4 kg/ m<sup>2</sup>). Average number of annual AVS procedures increased from 7 in the 2004–2011 period to 29 in the 2012–2018 period (<italic>p</italic> &lt; 0.001). AVS had to be repeated in 10% of procedures; it was successful in 77% of procedures and 86% of patients. The proportion of patients with successful AVS (92% in 2012–2018 <italic>vs</italic>. 66% in 2004–2011, <italic>p</italic> &lt; 0.001) and of successful AVS procedures (82% <italic>vs</italic>. 61%, <italic>p</italic> &lt; 0.001) was statistically significantly higher in the recent period.</p></sec><sec id="j_raon-2020-0052_s_009_w2aab3b7d146b1b6b1aab1c16b4Aa"><h3>Conclusions</h3><p>Number of AVS procedures and success rate at our center increased over time. Introduction of a dedicated radiologist and technical advance expanded and improved the AVS practice.</p></sec></abstract>

BackgroundAdrenal vein sampling (AVS) is essential for diagnostics of primary aldosteronism, distinguishing unilateral from bilateral disease and determining treatment options. We reviewed the performance of AVS for primary aldosteronism at our center during first 15 years, comparing the initial period to the period after the introduction of a dedicated radiologist. Additionally, AVS outcomes were checked against CT findings and the proportion of operated patients with proven unilateral disease was estimated.Patients and methodsA retrospective cross-sectional study conducted at the national endocrine referral center included all patients with primary aldosteronism who underwent AVS after its introduction in 2004 until the end of 2018. AVS was performed sequentially during Synacthen infusion. When the ratio of cortisol concentrations from adrenal vein and inferior vena cava was at least 5, AVS was considered successful.ResultsData from 235 patients were examined (168 men; age 32–73, median 56 years; BMI 18–48, median 30.4 kg/ m2). Average number of annual AVS procedures increased from 7 in the 2004–2011 period to 29 in the 2012–2018 period (p < 0.001). AVS had to be repeated in 10% of procedures; it was successful in 77% of procedures and 86% of patients. The proportion of patients with successful AVS (92% in 2012–2018 vs. 66% in 2004–2011, p < 0.001) and of successful AVS procedures (82% vs. 61%, p < 0.001) was statistically significantly higher in the recent period.ConclusionsNumber of AVS procedures and success rate at our center increased over time. Introduction of a dedicated radiologist and technical advance expanded and improved the AVS practice.

Adrenal vein sampling for primary aldosteronism: a 15-year national referral center experience

Radiology and Oncology

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.

BackgroundAdrenal vein sampling (AVS) is essential for diagnostics of primary aldosteronism, distinguishing unilateral from bilateral disease and determining...

Characteristic	Descriptive statistics
n	235
Male patients	168 (71%)
Age (years)	56 (32–73)
Body Mass Index (kg/m²)	30.4 (18.3–48.4)
Systolic BP at presentation (mm Hg)	155 (145–170)
Diastolic BP at presentation (mm Hg)	90 (80–95)
Number of antihypertensive agents	3 (2–4)
Hypokalemia	172 (73%)
eGFR (ml/min/1.73 m²)	88 (71–102)
Baseline aldosterone (nmol/L)	0.7 (0.3–8.8)
Baseline PRA (ng/mL/h)	0.2 (0.2–0.9)
Baseline ARR	4.2 (1.1–43.8)
CT = not performed in one patient; ARR = serum aldosterone-to-renin ratio; BP = blood pressure; eGFR = estimated glomerular filtration rate; PRA = plasma renin activity; Descriptive statistics are reported as median (interquartile range) for numeric variables and number (percentage) for categorical variables; normal / bilateral / unilateral	66 (28%) / 24 (10%) / 144 (62%)
Tumor size on CT (mm)	13 (8–19)

Adrenal vein sampling for primary aldosteronism: a 15-year national referral center experience

Article Category: Research Article

Published Online: Aug 05, 2020

Page range: 409 - 418

Received: Apr 14, 2020

Accepted: Jul 12, 2020

DOI: https://doi.org/10.2478/raon-2020-0052

© 2020 Tomaz Kocjan, Mojca Jensterle, Gaj Vidmar, Rok Vrckovnik, Pavel Berden, Milenko Stankovic, published by Sciendo

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.

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Clinical characteristics and laboratory parameters of the patients