Endocrine Abstracts

Introduction: Primary hyperaldosteronism (PA) can affect up to 10% of patients with hypertension. Adrenal vein sampling (AVS) is used to distinguish between unilateral and bilateral aldosterone production. However, it is invasive, technically challenging and is only performed in a limited number of centres. This audit aimed to evaluate the effectiveness of AVS in informing the management of PA in a large teaching hospital.

Methods: A retrospective audit of all AVS (n=38) performed in LTHT from 2011 to 2020 was conducted. Half of the cases were excluded due to limited access to data from regional referrals. Data collected included patients’ age at time of sampling, biochemistry, radiological and histological findings and outcomes following AVS.

Results: Of the 19 patients who underwent AVS, the average age at time of sampling was 54.5 and 12 (63%) were males. All patients had hypertension and 16 (84%) had >1 episode of hypokalaemia. 15 (79%) patients had radiological evidence of unilateral disease. 8 (42%) patients underwent a saline infusion test prior which demonstrated failure to suppress aldosterone secretion. AVS was unsuccessful in 8 (42%) patients due to failure in cannulating the right adrenal vein. Lateralisation was demonstrated in 7 (64%) patients, of which 6 (86%) were concordant with radiology. Following AVS, 11 (58%) patients underwent unilateral adrenalectomy. Hypokalaemia resolved in all patients (9) following surgery and 9 patients (82%) had reduction in the number of antihypertensive medications. Histology demonstrated unilateral adenoma consistent with Conn’s tumour in majority (80%) of the cases. AVS results informed decisions regarding conservative or surgical management in 13 (68%) patients.

Conclusion: Despite failure due to technical difficulty in a significant proportion of cases, AVS remained useful in informing the management of patients with PA. The vast majority of patients following successful AVS and subsequent surgery had positive outcomes and concordant histology.