SFEBES2021 Poster Presentations Adrenal and Cardiovascular (45 abstracts)
Method of venesection and location of peripheral sample alter adrenal venous sampling results and interpretation in primary aldosteronism
Vishnou Mourougavelou 1 , Xilin Wu 1,2 , Emily Goodchild 1,2 , Giulia Argentesi 1,2 , Kate Laycock 1,2 , Scott Akker 1,2 , Maralyn Druce 1,2 , Candy Sze 1 , Mona Waterhouse 1 , Anne Dawnay 3 , Matthew Matson 1 , Morris Brown 2 , William Drake 1,2 & Sam O’Toole 1,2,4
1St Bartholomew’s Hospital, London, United Kingdom; 2Queen Mary University of London, London, United Kingdom; 3Barts Health NHS Trust, London, United Kingdom; 4The Royal Hallamshire Hospital, Sheffield, United Kingdom
Introduction: Adrenal venous sampling (AVS) is the criterion standard method of lateralisation in primary aldosteronism (PA). Despite this pivotal role, there is limited consensus and significant variability between centres related to many of the technical aspects of AVS. In this study, we sought to address whether variations in two different technical aspects of AVS altered parameters and interpretation, namely: 1. Peripheral sample site 2. Method of adrenal vein (AV) venesection
Methods: Retrospective single centre analysis of 147 PA patients who underwent ACTH-stimulated AVS between 2018 and 2021. Peripheral samples were obtained from the infra-renal inferior vena cava (IVC) and the iliac vein. Two samples were obtained from each AV: one under gravity (sample 1), the other under gentle negative pressure (sample 2). All samples were analysed for aldosterone (A) and cortisol (C) by immunoassay.
Results: Both aldosterone and cortisol concentrations were significantly higher in IVC than iliac vein samples. The selectivity index (AVC/PVC) was lower when the IVC was used as the peripheral sample and resulted in up to 5% of AV samples being classified as unsuccessfully cannulated compared to the iliac vein sample. In the left AV, aldosterone, cortisol and the A/C ratio were all significantly higher in sample 2 than sample 1. In the right AV, cortisol was significantly higher in sample 1 than sample 2. The overall lateralisation index (dominant AVA/C/non-dominant AVA/C) was not significantly different between the two samples; however, in 12% of cases there was a difference in lateralisation result depending on the sample used.
Conclusions: Both the location of peripheral sample and method of AV venesection have significant impact on ACTH-stimulated AVS results. The iliac vein appears to be a better choice of peripheral sample than the IVC, whilst the optimal method of AV venesection remains to be determined.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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