Efficacy of adrenal venous sampling is increased by point of care cortisol analysis

Abstract

Primary aldosteronism (PA) is a common cause of secondary hypertension and is caused by unilateral or bilateral adrenal disease. Treatment options depend on whether the disease is lateralized or not, which is preferably evaluated with selective adrenal venous sampling (AVS). This procedure is technically challenging, and obtaining representative samples from the adrenal veins can prove difficult. Unsuccessful AVS procedures often require reexamination. Analysis of cortisol during the procedure may enhance the success rate. We invited 21 consecutive patients to participate in a study with intra-procedural point of care cortisol analysis. When this assay showed nonrepresentative sampling, new samples were drawn after redirection of the catheter. The study patients were compared using the 21 previous procedures. The intra-procedural cortisol assay increased the success rate from 10/21 patients in the historical cohort to 17/21 patients in the study group. In four of the 17 successful procedures, repeated samples needed to be drawn. Successful sampling at first attempt improved from the first seven to the last seven study patients. Point of care cortisol analysis during AVS improves success rate and reduces the need for reexaminations, in accordance with previous studies. Successful AVS is crucial when deciding which patients with PA will benefit from surgical treatment.

Improved technical success and radiation safety of adrenal vein sampling using rapid, semi-quantitative point-of-care cortisol measurement

“…Intraprocedural cortisol measurement has been found to increase the success rates of AVS by providing feedback to the interventionist before study completion, but such approaches have involved standard or modified laboratory equipment and methods for the quantitative measurement of cortisol by immunoassay. [9][10][11][12] These modified methods are still relatively slow, significantly prolonging the procedure and, in order to provide a collocated service to the interventional suite, may require significant infrastructure expenditure.…”

Clinical Characteristics and Long-Term Outcome of Primary Aldosteronism in a Norwegian Population

“…The proportion of patients with successful AVS was in the middle range of that reported by others [11,29], but has become very high after the introduction of point-of care cortisol analysis [27]. The patients with unilateral PA had significantly lower minimum potassium levels and higher post-SIT aldosterone levels than the patients with bilateral PA.…”

“…Persistent HT was defined as unchanged or worsening BP with the same or an increased number of antihypertensive drugs. The medically treated patients who either had no AVS performed or a non-representative AVS result, were at the follow-up visit offered a second AVS with point of care cortisol-analysis, which was introduced at HUS in 2013 [27].…”

Adrenal Vein Sampling: Radiation Dose Reduction on New Angiography Platform

“…Less-experienced operators, however, may fail to catheterize the right adrenal vein in up to 50% of cases, and several techniques have been tried in an attempt to improve these results including intraprocedural CBCT, which has reported successful catheterization rates of 89-95% [16][17][18][19] and intraprocedural cortisol assays with reported success rates of 81%-93%. [20,21] The first of these is associated with an increased radiation dose, and both are costlier than the conventional catheterization technique described here. The median DAP during AVS in the study was 11.3 Gy.cm 2 , which is lower than previously published reports ranging between 32.5 Gy.cm 2 and 72.2 Gy.cm 2 [8][9][10][11] including on some new generation angiography machines.…”