Influence of diagnostic criteria on the interpretation of adrenal vein sampling

Guidelines promote the use of adrenal vein sampling (AVS) to document lateralized aldosterone hypersecretion in primary aldosteronism. However, there are large discrepancies between institutions in the criteria used to interpret its results. This study evaluates the consequences of these differences on the classification and management of patients. The results of all 537 AVS procedures performed between January 2001 and July 2010 in our institution were interpreted with 4 diagnostic criteria used in experienced institutions where AVS is performed without cosyntropin (Brisbane, Padua, Paris, and Turin) and with criteria proposed by a recent consensus statement. AVS procedures were classified as unsuccessful, lateralized, or not lateralized according to each set of criteria. Almost 5× more AVS procedures were classified as unsuccessful with the strictest criteria than with the least strict criteria (18% versus 4%, respectively). Similarly, over 2× more AVS procedures were classified as lateralized with the least stringent criteria than with the most stringent criteria (60% versus 26%, respectively). Multiple samples were available from ≥1 side for 155 AVS procedures. These procedures were classified differently by ≥2 right-left sample pairs in 12% to 20% of cases. Thus, different sets of criteria used to interpret AVS in experienced institutions translate into heterogeneous classifications and hence management decisions, for patients with primary aldosteronism. Defining the most appropriate procedures and diagnostic criteria is needed for AVS to achieve optimal performance and fully justify its status as a gold standard.