Central Surgical AssociationModification of the protocol for selective adrenal venous sampling results in both a significant increase in the accuracy and necessity of the procedure in the management of patients with primary hyperaldosteronism
Section snippets
Methods
After the publication of our initial AVS results, a critical appraisal of our practice was undertaken. After the identification of numerous factors believed to have contributed to this poor performance, a new protocol at the University of Calgary was instituted. Since 2006, all patients with documented PA deemed to be appropriate operative candidates, regardless of the imaging findings, were subjected to AVS performed by a single radiologist. ACTH (Cortrosyn) stimulation with a 250-μg bolus
Results
Eighty-six AVS procedures were performed in 84 patients. The median age of this group of patients was 50 years. Forty-four patients were female. Median systolic and diastolic blood pressures at presentation were 148 mm Hg and 90 mm Hg, respectively. Patients were on a median of 2.5 antihypertensive medications (range, 0–5). Hypokalemia was noted in 62% (52/84) patients at presentation. Median aldo:renin ratio was 14,950 (Table I). BAVC was documented in 82 of 86 procedures (95.3%), which
Discussion
During the critical appraisal of our AVS protocol, several factors believed to have limited performance were identified: (1) multiple radiologists; (2) multiple centers; (3) first-year fellows involved in 30% of procedures; (4) lack of ACTH infusion at some centers; and (5) inconsistent standards/cutoffs for interpretation. The described change in the AVS protocol at the University of Calgary resulted in a biochemical success rate of 95% since 2006. Our previously reported low success rate was
References (22)
- et al.
Clinical outcome after laparoscopic adrenalectomy for primary hyperaldosteronism: the role of pathology
Surgery
(2010) - et al.
Role for adrenal venous sampling in primary aldosteronism
Surgery
(2004) - et al.
Primary aldosteronism. Diagnostic evaluation
Endocrinol Metab Clin North Am
(1988) - et al.
Consequences of adrenal venous sampling in primary hyperaldosteronism and predictors of unilateral adrenal disease
J Am Coll Surg
(2010) - et al.
The role of radiologic studies in the evaluation and management of primary hyperaldosteronism
Surgery
(2008) - et al.
Is adrenal venous sampling necessary in all patients with hyperaldosteronism before adrenalectomy?
J Vasc Interv Radiol
(2008) - et al.
Primary aldosteronism: results of adrenalectomy for nonsingle adenoma
J Am Coll Surg
(2011) - et al.
Primary aldosteronism: a new clinical entity
Trans Assoc Am Phys
(1955) - et al.
Increased diagnosis of primary aldosteronism, including surgically correctable forms, in centers from five continents
J Clin Endocrinol Metab
(2004) - et al.
High rate of detection of primary aldosteronism, including surgically treatable forms, after 'non-selective' screening of hypertensive patients
J Hypertens
(2003)
Long-term results of endoscopic adrenalectomy for Conn's syndrome
Am Surg
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Adrenal venous sampling in primary aldosteronism: lessons from over 600 single-operator procedures
2022, Clinical RadiologyCitation Excerpt :Centres with multiple operators have lower success rates than do centres with one or two expert radiologist operators.16–20 Our own success rate increased markedly after the first 5 years of the programme21 and upon moving to single-operator status. We suggest that a minimum of 25 AVS procedures per year per operator is likely needed to maintain adequate technical success.
Evaluation of Adrenal Vein Sampling Use and Outcomes in Patients With Primary Aldosteronism
2020, Journal of Surgical ResearchCan incomplete adrenal venous sampling data be used in predicting the subtype of primary aldosteronism?
2019, Annales d'Endocrinologie