Subtyping of Primary Aldosteronism by Adrenal Venous Sampling

Area of Science:

• Endocrinology
• Interventional Radiology
• Hypertension Management

Background:

• Primary aldosteronism (PA) is a common, surgically curable cause of hypertension.
• Adrenal venous sampling (AVS) is recommended for identifying unilateral PA but is underutilized due to perceived technical challenges and interpretation difficulties.
• Concerns regarding AVS complications, though rare, also limit its adoption.

Purpose of the Study:

• To provide updated information on adrenal venous sampling (AVS) for subtyping primary aldosteronism (PA).
• To review patient selection, preparation, procedural performance, and result interpretation for AVS.
• To discuss situations where AVS may be omitted and alternative imaging techniques for identifying surgically curable PA.

Main Methods:

• Review of recent studies and advancements in AVS for PA diagnosis.
• Discussion of technical aspects, including the use of microcatheters and androstenedione.
• Exploration of alternative functional imaging techniques.

Main Results:

• Recent studies have improved the understanding and application of AVS, enabling more effective diagnosis of unilateral PA.
• Technological advancements like microcatheters enhance AVS success rates.
• Alternative imaging modalities are being explored to address AVS availability limitations.

Conclusions:

• Optimizing AVS performance and interpretation is key to increasing its utilization for diagnosing curable PA.
• Careful patient selection and preparation are essential for successful AVS.
• Alternative strategies and imaging techniques may help overcome AVS accessibility issues, expanding treatment options for PA.