Adrenal vein sampling in primary aldosteronism: towards a standardised protocol

Area of Science:

• Endocrinology
• Internal Medicine

Background:

• Primary aldosteronism has subtypes requiring distinct therapeutic approaches.
• Adrenal vein sampling (AVS) is the gold-standard for subtype diagnosis per Endocrine Society guidelines.
• Current AVS practice lacks standardized protocols for performance and interpretation.

Purpose of the Study:

• To provide evidence-based answers to common clinical questions regarding AVS.
• To offer expert opinions on optimizing AVS performance and interpretation.
• To address challenges in AVS, particularly for less experienced centers.

Main Methods:

• Review of existing evidence and clinical guidelines.
• Expert opinion and consensus-based recommendations.
• Discussion of practical aspects of AVS, including patient preparation and procedural techniques.

Main Results:

• Standardized criteria for AVS cannulation and lateralization are proposed.
• Guidance on the use of ACTH (1-24) and contralateral suppression is provided.
• Strategies to improve AVS success rates, especially in centers with limited experience, are discussed.

Conclusions:

• Standardizing adrenal vein sampling is essential for accurate primary aldosteronism diagnosis.
• Addressing current practice variations will improve patient management and outcomes.
• This review aims to enhance the reliability and accessibility of AVS.