Presentation Details
| The Clinical Aspects of Adrenal Vein Sampling: Criteria for Medical Vs.surgical management Sharon/N John1, Anil Pillai2, Girish Kumar2, Alex da Silva 2, Akhilesh Pillai3. 1UNT Health Texas College of Osteopathic Medicine, Fort Worth, TX, USA.2University of Texas Southwestern Medical Center, Dallas, TX, USA.3The University of Texas Health Science Center at Houston, Houston, TX, USA |
Abstract
BACKGROUND: Adrenal vein sampling (AVS) differentiates unilateral from bilateral primary hyperaldosteronism (PA), crucial to making treatment decisions. Bilateral results indicate adrenal hyperplasia, which is found in 50-70% of patient cases and is managed medically. Unilateral aldosterone production is identified in approximately 30-50% of AVS cases. These cases are seen with unilateral adrenal hyperplasia or microadenomas, which are often treated surgically with adrenalectomy or adrenal ablation.
METHODS: Clinic visits are essential for maintaining clarity, trust, and safety between physician and patient. Pre-procedural counseling should address risks, expectations, and the rationale for the procedure’s benefits. Sampling ratios are reviewed with patients to guide interpretation and treatment planning. Adrenal vein and IVC samples are used to calculate the selectivity index (SI) and lateralization index (LI) for diagnostic accuracy. An SI ≥ 3 confirms successful adrenal vein cannulation, while an LI ≥ 4 indicates unilateral aldosterone secretion. The contralateral suppression index, with values <1, reflects suppression of aldosterone production on the non-dominant side due to contralateral hypersecretion.
RESULTS: Adrenal vein sampling (AVS) is the gold standard for distinguishing unilateral from bilateral aldosterone hypersecretion in primary aldosteronism, surpassing imaging, which often misclassifies incidental nodules. Unilateral disease responds well to adrenalectomy, correcting hypokalemia, improving blood pressure, and reversing cardiac remodeling. Bilateral hyperplasia is treated medically with mineralocorticoid receptor antagonists, achieving control but seldom full remission. Adrenal ablation is a potential option for non-surgical candidates, though long-term data are limited. AVS complications are rare, and cone-beam CT and rapid cortisol assays improve procedural accuracy and safety.
CONCLUSIONS: Adrenal Vein Sampling (AVS) uses sampling ratios to differentiate unilateral from bilateral aldosterone production in PA patients. This is essential for guiding treatment decisions in PA patients, leading to medical management, adrenalectomy, or adrenal ablation. Overall, AVS remains essential for precision diagnosis and individualized management, bridging endocrinologic evaluation with perioperative decision-making to reduce long-term cardiovascular risk.
No part of this publication may be reproduced, distributed, or transmitted in any form or by any means, including photocopying, recording, or other electronic or mechanical methods, without the prior written permission of the author.
METHODS: Clinic visits are essential for maintaining clarity, trust, and safety between physician and patient. Pre-procedural counseling should address risks, expectations, and the rationale for the procedure’s benefits. Sampling ratios are reviewed with patients to guide interpretation and treatment planning. Adrenal vein and IVC samples are used to calculate the selectivity index (SI) and lateralization index (LI) for diagnostic accuracy. An SI ≥ 3 confirms successful adrenal vein cannulation, while an LI ≥ 4 indicates unilateral aldosterone secretion. The contralateral suppression index, with values <1, reflects suppression of aldosterone production on the non-dominant side due to contralateral hypersecretion.
RESULTS: Adrenal vein sampling (AVS) is the gold standard for distinguishing unilateral from bilateral aldosterone hypersecretion in primary aldosteronism, surpassing imaging, which often misclassifies incidental nodules. Unilateral disease responds well to adrenalectomy, correcting hypokalemia, improving blood pressure, and reversing cardiac remodeling. Bilateral hyperplasia is treated medically with mineralocorticoid receptor antagonists, achieving control but seldom full remission. Adrenal ablation is a potential option for non-surgical candidates, though long-term data are limited. AVS complications are rare, and cone-beam CT and rapid cortisol assays improve procedural accuracy and safety.
CONCLUSIONS: Adrenal Vein Sampling (AVS) uses sampling ratios to differentiate unilateral from bilateral aldosterone production in PA patients. This is essential for guiding treatment decisions in PA patients, leading to medical management, adrenalectomy, or adrenal ablation. Overall, AVS remains essential for precision diagnosis and individualized management, bridging endocrinologic evaluation with perioperative decision-making to reduce long-term cardiovascular risk.
No part of this publication may be reproduced, distributed, or transmitted in any form or by any means, including photocopying, recording, or other electronic or mechanical methods, without the prior written permission of the author.
Content Locked. Log into a registered attendee account to access this presentation.