Adrenal venous sampling as a diagnostic procedure for primary hyperaldosteronism: Experience from a tertiary referral centre

CONTEXT Adrenal vein sampling (AVS) is recommended in all patients with hyperaldos-teronism to whom surgery would be offered if the results indicated unilateral hypersecretion. OBJECTIVE To assess the performance of AVS against radiological findings and to evaluate the Endocrine Society’s Practice Guidelines for diagnostic cut-offs. PATIENTS Retrospective study of 41 patients with hyperaldosteronism who underwent both AVS and computed tomography (CT) imaging. RESULTS CT and AVS results were concordant in 73.7%. Unilateral lesions on CT had a greater positive predictive value (85%) than non-unilateral lesions (50%). In patients with subsequently confirmed adrenal adenomas, a lateralisation ratio >2 when comparing cortisol-corrected aldosterone ratios from the affected versus unaffected side was 100% sensitive. Patients who were managed surgically experienced significant reductions in blood pressure and medication burden and 46% were cured. CONCLUSIONS AVS is important in establishing unilateral or bilateral adrenal secretion of aldosterone in patients with primary hyperaldosteronism. However, it may not be essential for the work-up in patients below the age of 40, in whom adrenal incidentalomas adrenal incidentalomas are known to be rarer, and a unilateral lesion on CT therefore has a greater positive predictive value.