Related Experiment Video
Updated: Jan 8, 2026
06:08
A Novel Method: Super-selective Adrenal Venous Sampling
Published on: September 15, 2017
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Partially Successful Adrenal Vein Sampling With and Without Cross-Sectional Imaging in Primary Aldosteronism
Peeradon Vibhatavata1,2, Livia M Mermejo1,3, Lili Zhao4
1Division of Metabolism, Endocrinology and Diabetes (P.V., L.M.M., A.F.T.), University of Michigan, Ann Arbor.
Hypertension (Dallas, Tex. : 1979)
|December 18, 2025
Summary
Partially successful adrenal vein sampling (AVS) using the relative aldosterone secretion index (RASI) is unreliable for diagnosing primary aldosteronism (PA) subtypes. Significant RASI overlap across PA subtypes limits its utility in guiding adrenalectomy decisions.
Area of Science:
- Endocrinology
- Nephrology
- Surgical Oncology
Background:
- Adrenal vein sampling (AVS) is crucial for diagnosing primary aldosteronism (PA).
- The relative aldosterone secretion index (RASI) has been proposed to subtype PA using single adrenal vein cannulation.
- Existing data on RASI reliability for PA subtyping are inconsistent.
Purpose of the Study:
- To evaluate the reliability of RASI in guiding PA subtyping and treatment decisions.
- To assess the utility of partially successful AVS in differentiating PA subtypes.
- To determine if RASI can predict PA cure after adrenalectomy.
Main Methods:
- Retrospective cohort study of 460 PA patients undergoing AVS.
- AVS performed before and after cosyntropin stimulation.
- RASI calculated from simulated partially successful AVS (bilateral cannulation) and compared across PA subtypes.
Main Results:
- RASI showed substantial overlap between lateralized PA and bilateral PA, irrespective of cosyntropin stimulation.
- RASI thresholds previously proposed for PA subtyping misclassified a significant proportion of patients.
- RASI did not reliably predict PA cure after adrenalectomy.
- Combining RASI with imaging improved lateralization prediction, especially with cosyntropin-stimulated AVS.
Conclusions:
- Partially successful AVS, relying solely on RASI, is unreliable for PA subtyping.
- The significant overlap in RASI values across PA subtypes limits its clinical utility in guiding adrenalectomy.
- Further refinement or alternative methods are needed for accurate PA subtyping when bilateral AVS is not fully successful.
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