Endocrine Abstracts

Background: Measurement of the peripheral cortisol concentration is necessary for calculating selectivity ratio (SR) based on which is AVS success evaluated.

Objective: The goal of this study was to assess the necessity for two peripheral cortisol measurements in sequential AVS, one after cannulation of the adrenal vein on one side, and the second after cannulation on the other side.

Methods: This retrospective study included 142 bilaterally successful AVS procedures in patients with primary aldosteronism. All procedures were performed by two experienced interventional radiologists. AVS was performed under continuous stimulation with adrenocorticotrophic hormone. Blood samples were taken sequentially, first from the right adrenal vein followed by the infrarenal segment of the IVC (time 1=T1), then from the left adrenal vein followed by the infrarenal segment of the IVC (time 2=T2). The AVS was considered technically successful if the SR (cortisol ratio of each adrenal vein to the IVC) was 5:1. The Wilcoxon paired test was used to assess differences.

Results: Median T1 and T2 cortisol concentrations were 743 (IQR 600-952) nmol/l and 760 (IQR 620-984) nmol/l, respectively (P<0.001). Median T1 right SR was 30 (IQR 23-43), and T2 right SR was 29 (IQR 21-40), P<0.001. Median T1 left SR was 15 (IQR 10-23), and T2 left SR was 14 (IQR 10-22), P<0.001.

Conclusions: Although notable variations were observed in both absolute cortisol concentrations and SR at T1 and T2, these differences did not alter the overall conclusion regarding AVS accuracy in the patient group. Consequently, it might be considered that there is no imperative requirement for repetitive peripheral cortisol sampling during sequential AVS procedures under stimulation with adrenocorticotrophic hormone.