Endocrine Abstracts

Introduction: Adrenal venous sampling (AVS) is the reference standard test to differentiate between unilateral and bilateral adrenal diseases in patients with primary hyperaldosteronism. Current Endocrine society guidelines recommend AVS in all cases of primary hyperaldosteronism where surgery is desirable and practical. However, this procedure is technically challenging and failure rate is high.

Aims: The aim of this audit was to evaluate success rate of adrenal venous sampling at University College Hospital, London in a retrospective analysis.

Results: We audited all 16 AVS procedures performed on 14 patients in the last 3 years. A procedure was considered successful when adequate cannulation of both adrenal veins was demonstrated. We used cortisol gradient across adrenal vein and peripheral vein to establish success of venous cannulation and applied a cut off value of >2. Right adrenal vein cannulation was successful in 8 (50%) procedures. Left adrenal vein cannulation was successful in 12 (75%) procedures. Both adrenal veins were adequately cannulised in 6 (37%) procedures which were deemed successful. No significant procedure related complications were noted. We reviewed outcomes of the six successful cases. Two patients, who had idiopathic hyperaldosteronism were treated medically. Three patients underwent laparoscopic unilateral adrenalectomy. One (33%) of these three patients had complete cure of hypertension while the other two (66%) had significant improvement in blood pressure control. One patient awaits surgery.

Conclusion: This audit shows that success rate for AVS was nearly 40% at University College Hospital in a 3-year period. This is comparable to many centres across Europe although some centres have much higher success rate. Our success rate is likely to improve as the experience of the radiologists grows. In addition, intraprocedural cortisol measurement is being introduced at the centre which will facilitate further improvement.