Rapid cortisol assays improve the success rate of adrenal vein sampling for primary aldosteronism

Richard J. Auchus, Christina Michaelis, Frank H. Wians, Bart L. Dolmatch, Shellie C. Josephs, Clayton K. Trimmer, Matthew E. Anderson, Fiemu E. Nwariaku

Research output: Contribution to journalArticle

68 Citations (Scopus)

Abstract

OBJECTIVE:: We hypothesized that an adrenal vein sampling (AVS) algorithm incorporating rapid cortisol assays, which enables resampling of the adrenal veins, would improve the success rate by a team of radiologists. SUMMARY BACKGROUND DATA:: AVS is the most accurate means to localize aldosterone production in primary aldosteronism (PA). However, cannulation of the right adrenal vein (RAV) is difficult, and success is assumed from venography without the support of steroid assays. Furthermore, few institutions can assign all studies to 1 dedicated and experienced AVS interventional radiologist. METHODS:: Retrospective chart review of patients with PA at our university hospitals who underwent AVS. We compared results for 30 AVS studies incorporating rapid cortisol assays with 30 conventional AVS studies. RESULTS:: The success rate for the control period was 73% (22/30 studies). For the first 30 studies after incorporating rapid cortisol assay, the success rate increased to 97% (29/30 studies). Resampling the RAV was required for 2 studies, and prolonged sheath insertion did not cause any complications. CONCLUSIONS:: High AVS success rates may be achieved by a team of interventional radiologists at 1 center using defined AVS protocols. Rapid cortisol assay allows for resampling of the RAV and improves AVS success rates.

Original languageEnglish (US)
Pages (from-to)318-321
Number of pages4
JournalAnnals of Surgery
Volume249
Issue number2
DOIs
StatePublished - Feb 2009

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Hyperaldosteronism
Hydrocortisone
Veins
Sampling Studies
Phlebography
Aldosterone
Catheterization

ASJC Scopus subject areas

  • Surgery

Cite this

Rapid cortisol assays improve the success rate of adrenal vein sampling for primary aldosteronism. / Auchus, Richard J.; Michaelis, Christina; Wians, Frank H.; Dolmatch, Bart L.; Josephs, Shellie C.; Trimmer, Clayton K.; Anderson, Matthew E.; Nwariaku, Fiemu E.

In: Annals of Surgery, Vol. 249, No. 2, 02.2009, p. 318-321.

Research output: Contribution to journalArticle

Auchus, Richard J. ; Michaelis, Christina ; Wians, Frank H. ; Dolmatch, Bart L. ; Josephs, Shellie C. ; Trimmer, Clayton K. ; Anderson, Matthew E. ; Nwariaku, Fiemu E. / Rapid cortisol assays improve the success rate of adrenal vein sampling for primary aldosteronism. In: Annals of Surgery. 2009 ; Vol. 249, No. 2. pp. 318-321.
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abstract = "OBJECTIVE:: We hypothesized that an adrenal vein sampling (AVS) algorithm incorporating rapid cortisol assays, which enables resampling of the adrenal veins, would improve the success rate by a team of radiologists. SUMMARY BACKGROUND DATA:: AVS is the most accurate means to localize aldosterone production in primary aldosteronism (PA). However, cannulation of the right adrenal vein (RAV) is difficult, and success is assumed from venography without the support of steroid assays. Furthermore, few institutions can assign all studies to 1 dedicated and experienced AVS interventional radiologist. METHODS:: Retrospective chart review of patients with PA at our university hospitals who underwent AVS. We compared results for 30 AVS studies incorporating rapid cortisol assays with 30 conventional AVS studies. RESULTS:: The success rate for the control period was 73{\%} (22/30 studies). For the first 30 studies after incorporating rapid cortisol assay, the success rate increased to 97{\%} (29/30 studies). Resampling the RAV was required for 2 studies, and prolonged sheath insertion did not cause any complications. CONCLUSIONS:: High AVS success rates may be achieved by a team of interventional radiologists at 1 center using defined AVS protocols. Rapid cortisol assay allows for resampling of the RAV and improves AVS success rates.",
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