Adrenal vein sampling for primary aldosteronism: a 15-year national referral center experience
Background. Adrenal vein sampling (AVS) is a key part of the diagnostic workup of primary aldosteronism (PA), distinguishing unilateral from bilateral disease and determining treatment options. We aimed to review the performance of AVS for PA at our center during first 15 years. The initial period was compared to the period after the introduction of a single dedicated radiologist in 2012.
Patients and methods. A retrospective cross-sectional study conducted at the Slovenian national endocrine referral center included all patients with PA who underwent AVS after its introduction in 2004 until the end of 2018. AVS was performed sequentially during continuous Synacthen stimulation. When the ratio of cortisol concentrations from adrenal vein and inferior vena cava was at least 5, AVS was considered successful.
Results. Data from 235 patients were examined (168 men and 67 women; age 32-73, median 56 years; BMI 18-48, median 30.4 kg/m2). The average number of annual AVS procedures increased from 7 in the 2004-2011 period to 29 in the 2012-2018 period (p<0.001). AVS had to be repeated in 10% of the procedures; it was successful in 77% of the procedures and 86% of the patients. The proportion of patients with successful AVS (92% in 2012-2018 vs. 66% in 2004-2011, p<0.001) and of successful AVS procedures (82% vs. 61%, p<0.001) was statistically significantly higher in the recent period.
Conclusions. The number of AVS procedures at our center and the success rate increased over time. The introduction of a single, dedicated radiologist expanded and improved the AVS performance.
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