Intraprotocol Adrenal Vein Sampling Inconsistencies in Primary Aldosteronism Lateralization

Area of Science:

• Endocrinology
• Radiology
• Internal Medicine

Background:

• Primary aldosteronism (PA) diagnosis relies on adrenal vein sampling (AVS) to identify lateralization.
• Current AVS protocols may have intraprotocol variability affecting lateralization results.
• Understanding this variability is key for accurate PA subtyping and surgical candidacy.

Purpose of the Study:

• To quantify intraprotocol lateralization inconsistencies during simultaneous AVS.
• To compare variability between baseline and cosyntropin-stimulated AVS measurements.

Main Methods:

• Retrospective analysis of 402 patients with PA undergoing simultaneous AVS.
• Six sample sets (three baseline, three post-cosyntropin stimulation) analyzed.
• Lateralization index (LI) of ≥4 defined as lateralized PA; inconsistencies assessed across triplicate samples.

Main Results:

• 32.1% of patients exhibited at least one lateralization inconsistency.
• Inconsistencies were more frequent in baseline (22.1%) than stimulated (13.2%) AVS sets.
• Highest variability observed in baseline samples and in the adrenal vein with lower aldosterone output.

Conclusions:

• Significant intraprotocol variability exists in AVS lateralization results.
• Baseline AVS measurements demonstrate higher inconsistency than cosyntropin-stimulated measurements.
• These findings highlight potential challenges in AVS interpretation and the need for protocol optimization.