Update: Selective adrenal venous sampling (AVS) - Indication, technique, and significance

Area of Science:

• Endocrinology
• Interventional Radiology
• Hypertension Management

Background:

• Primary aldosteronism (PA) is a common cause of secondary hypertension.
• Distinguishing unilateral (adrenal aldosterone-producing adenoma - APA) from bilateral (bilateral adrenal hyperplasia - BAH) PA is crucial for treatment.
• Current screening and imaging lack reliability in differentiating unilateral from bilateral PA.

Purpose of the Study:

• To review the indications, techniques, and significance of selective adrenal venous sampling (AVS) for PA.
• To provide an overview of PA etiology, diagnostics, and therapeutic options.
• To highlight the role of AVS in differentiating unilateral from bilateral adrenal disease.

Main Methods:

• Review of current literature and authors' experience regarding AVS in PA.
• Detailed examination of AVS indication and technique.
• Evaluation of AVS relevance in clinical decision-making for PA patients.

Main Results:

• AVS reliably verifies or excludes unilaterally dominated aldosterone secretion.
• Successful AVS enables curative adrenalectomy for patients with unilateral APA.
• AVS is a safe, minimally invasive method with high success rates when performed by experienced radiologists.

Conclusions:

• AVS is an established diagnostic tool for differentiating unilateral from bilateral adrenal disease in PA.
• Verification of lateralization by AVS has direct therapeutic implications for PA patients.
• AVS offers low radiation exposure and avoids contrast medium, enhancing patient safety.