ISRA May 2022

A Novel Rapid Intraprocedural Cortisol Assay Used in Adrenal Vein Sampling: Initial Experience

Hannah Silverman 1 Itamar Tamir 1 Alexander Klimaov 1 Kira Oleinikov 3 Mattan Fischer 3 Ido Ben-Dov 2 Allan Bloom 1
1Medical Imaging, Interventional and Vascular Radiology unit, Hadassah University Medical Center, Israel
2Nephrology, Hadassah University Medical Center, Israel
3Endocrinology, Hadassah University Medical Center, Israel

Background: Adrenal vein sampling (AVS) may be crucial in distinguishing between aldosterone-producing adenoma (APA) and bilateral adrenal hyperplasia (BAH). Selective adrenal venography is technically challenging. Immunoassay hormone level measurements take hours to weeks to obtain results. A rapid Cortisol assay (rCA) might improve diagnostic accuracy, shorten procedure time, reduce radiation exposure, as well as the need for repeat procedures.

Purpose: To report our initial experience with a novel rCA during AVS and to compare it with historical data.

Materials and Methods: In three of fifteen patients (20%) undergoing AVS the rCA test was used in addition to standard procedure. Venous samples were analyzed intra-procedurally by a nephrologist or endocrinologist. The rCA result was reported immediately to the angiographer. Data collected include biochemistry, imaging and procedure duration.

Results: There were ten males/ five females, mean age 48.3, range 30-72 years, with a clinical diagnosis of hyperaldosteronism: hypertension, hypokalemia and an elevated aldosterone/renin ratio. Imaging before AVS suggested unilateral adrenal pathology (7), bilateral (5), normal (5) and unknown (1).

Of the 12 procedures performed using only the standard reference tests, ten (83%) were defined retrospectively as successful cannulation of both adrenal veins. All three examinations using the rCA were successful with a shorter procedure duration (average 26.3 min vs 47.2 min) and results available within several minutes. Higher adrenal vein cortisol levels were seen when compared to the periphery, with 100% correlation to the reference standard tests. In four patients, one rCA and three without, no lateralization was demonstrated implying a diagnosis of bilateral hyperplasia. No procedural complications occurred.

Conclusions: The use of a novel rCA appears reduce procedure time whilst providing instant reassurance of successful AVS. Further study is warranted to determine if radiation exposure is reduced and repeat AVS avoided.