Adrenal Venous Sampling for diagnosis of Primary Hyperaldosteronism

Background:

Primary Hyperaldosteronism is caused by overproduction of aldosterone in one or both adrenal glands. According to international guidelines, patients over 40 years old should have adrenal venous sampling (AVS) to distinguish between bilateral and unilateral disease. The aim of this study was to investigate the learning curve and safety of AVS, as well as advantages and pitfalls of the procedure.

Methods:

A retrospective study was performed on all AVS procedures done in Shaare-Zedek Medical-Center. Data collection included pre-procedure clinical information, adrenal imaging, AVS results and follow up. AVS protocol and interpretation of results were done according to International guidelines.

Results:

Since 2018, 25 AVS procedures were done for 24 patients. Mean age 54.1±9y, 20/25(80%) males. In 20/25(80%) the procedure was fully successful, with improvement over time, from 68% for the first twelve to 92% for the last twelve. In 5/25(20%) there was inability to locate the right adrenal vein; in four of whom lateralization was demonstrated by contralateral suppression. Overall 24/25(96%) had a conclusive result. In 10/24(42%) adrenal imaging was not accurate in confirming lateralization. No complications were observed. 12/17 patients with confirmed lateralization had unilateral adrenalectomy; all of them became normotensive with fewer or no medications for hypertension.

Conclusion:

AVS is a safe and efficient procedure and learning curve can be achieved after 12 cases. This series had a 96% conclusive lateralization result. With the known limitations of adrenal imaging to locate hyperaldosteronism source, AVS is a critical step in the management of primary hyperaldosteronism.