Preoperative supine time for adrenal venous sampling: a prospective randomized controlled trial

Area of Science:

• Endocrinology
• Cardiology
• Hypertension Research

Background:

• Primary aldosteronism (P.A.) is the leading cause of secondary hypertension, significantly increasing risks of severe organ damage and mortality.
• Adrenal venous sampling (AVS) is crucial for differentiating aldosterone-producing adenoma from bilateral adrenal hyperplasia, guiding treatment decisions between surgery and medication.
• Current guidelines recommend supine positioning before AVS, but optimal duration remains uninvestigated.

Purpose of the Study:

• To determine the impact of preoperative supine positioning duration on the diagnostic efficacy of AVS in P.A. patients.
• To compare biochemical and clinical remission rates between patients undergoing 15-minute versus 2-hour supine AVS.
• To optimize AVS protocols for improved accuracy in diagnosing and subtyping P.A.

Main Methods:

• A multi-center prospective randomized controlled study involving 120 P.A. patients undergoing AVS.
• Random allocation into two groups: 15-minute supine time versus 2-hour supine time.
• Primary outcome: biochemical remission (serum potassium, orthostatic aldosterone-to-renin ratio); Secondary outcomes: clinical remission, technical success, adverse events.

Main Results:

• Analysis of biochemical remission, including serum potassium and orthostatic ARR, between the two supine time groups.
• Evaluation of clinical remission parameters such as blood pressure and antihypertensive medication requirements.
• Assessment of AVS technical success rates and incidence of adverse events.

Conclusions:

• The study aims to provide evidence-based recommendations for preoperative supine duration in AVS.
• Findings will contribute to refining AVS procedures for more accurate P.A. diagnosis and subtyping.
• Optimizing AVS protocols can lead to improved patient outcomes in managing primary aldosteronism.