ECE2023 Eposter Presentations Adrenal and Cardiovascular Endocrinology (124 abstracts)
Implementation of a new adrenal venous sampling (AVS) protocol for primary aldosteronism: early data from a single tertiary centre
Deirdre Green 1 , Vanessa Farnan 1 , Tara McDonnell 1,2 , Sabah Abdelfadil 3 , Karen Heverin 3 , Claire Carthy 1 , Shari Srinivasan 3 , Arnold Hill 4,5 , Neal Dugal 4,5 , Martina Morrin 6 , Ruth Dunne 6 , Douglas Mulholland 6 , Amar Agha 1,2 , Mark Sherlock 1,2 & Michael O’Reilly 1,2
1Beaumont Hospital, Endocrinology, Dublin, Ireland; 2Royal College of Surgeons in Ireland, Endocrinology, Dublin, Ireland; 3Beaumont Hospital, Chemical Pathology, Dublin, Ireland; 4Beaumont Hospital, Surgery, Dublin, Ireland; 5Royal College of Surgeons in Ireland, Surgery, Dublin, Ireland; 6Beaumont Hospital, Radiology, Dublin, Ireland
Primary aldosteronism (PA) is the most common cause of endocrine hypertension. Following biochemical confirmation of aldosterone excess, adrenal venous sampling (AVS) is the gold standard investigation to lateralise the source of aldosterone hypersecretion in patients deemed suitable for potential adrenalectomy. AVS has been performed for all suitable patients with a diagnosis of PA in Beaumont Hospital since implementation of a new protocol involving collaboration between Endocrinology, Chemical Pathology and Interventional Radiology in 2021. We aimed to review the outcome of all AVS procedures in Beaumont Hospital between November 2021 and December 2022, with a focus on rates of successful cannulation and the incidence of unilateral versus bilateral disease. We identified 13 patients with PA who were referred for AVS between November 2021 and December 2022. Median age was 46 [IQR 37–51 years] and 38.5% were female. Patients had hypertension for a median of 15 years [IQR 6–25 years]. 53.8% had a history of hypokalaemia. Confirmatory testing with saline suppression test was performed in 10 of 13 cases. The median post saline suppression aldosterone level was 498.5pmol/l [IQR 442 -732pmol/l]. Imaging reported a unilateral adenoma in 61.5% of cases, with a median adenoma diameter of 2 cm [IQR 1.05–3.05 cm]. Sixteen AVS procedures were performed, as 3 patients required a repeat procedure. Bilateral adrenal vein cannulation was successful in 10 of 16 cases [62.5%]. Results of one patient who was successfully cannulated were disregarded as she had taken oral Prednisolone the day prior to the procedure. All patients were discussed at a multidisciplinary team meeting. Unilateral hypersecretion was confirmed in 3 of 9 cases [33.3%]. Out of 5 patients with bilateral disease on AVS, 2 had a unilateral adenoma on imaging. One patient was referred for repeat procedure due to discordant results. AVS is the gold standard means of differentiating unilateral from bilateral forms of PA. Early success rates within the first 12 months in Beaumont Hospital are in line with accepted international standards and will continue to improve with accumulated experience and case throughput. AVS has helped to identify patients suitable for adrenalectomy in our centre, while inappropriate adrenalectomies have also been avoided in a subset of patients.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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