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A Novel Method: Super-selective Adrenal Venous Sampling
Published on: September 15, 2017
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Diagnostic criteria for adrenal venous sampling.
Olivier Steichen1, Laurence Amar
1aInternal Medicine Department, AP-HP, Tenon HospitalbFaculty of Medicine, Sorbonne Universités, UPMC University Paris 06cINSERM, Sorbonne Universités, UPMC Univ Paris 06, UMR_S1142dFaculty of Medicine, Université Paris-DescarteseHypertension Unit, AP-HP, Georges Pompidou European HospitalfINSERM, UMR_S970, équipe 14, Paris, France.
Current Opinion in Endocrinology, Diabetes, and Obesity
|April 28, 2016
Summary
Adrenal vein sampling (AVS) is crucial for primary aldosteronism surgery. Current AVS protocols lack evidence, prompting expert recommendations for standardized clinical practice and future research.
Area of Science:
- Endocrinology
- Interventional Radiology
- Nephrology
Background:
- Primary aldosteronism affects 3-5% of hypertension cases.
- Unilateral aldosterone hypersecretion is surgically treatable via adrenalectomy.
- Adrenal vein sampling (AVS) is recommended to confirm unilateral disease before surgery.
Purpose of the Study:
- To review current AVS protocols for primary aldosteronism.
- To highlight the lack of evidence supporting specific AVS protocols.
- To propose expert recommendations for clinical practice and research.
Main Methods:
- Review of existing AVS protocols and emerging trends.
- Discussion of techniques to improve adrenal vein cannulation.
- Exploration of novel markers and interpretation strategies for AVS.
Main Results:
- No consensus exists on optimal AVS protocols or interpretation.
- Emerging trends include radiologist training, CT imaging, and rapid cortisol assays.
- Cosyntropin stimulation is used but its diagnostic benefit is unclear.
- New markers and strategies for failed AVS are under investigation.
Conclusions:
- Standardization of AVS protocols is needed due to varied practices.
- Further research is required to validate new techniques and markers.
- Alternative methods for diagnosing primary aldosteronism subtypes may be necessary.
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