Sampling variability and concordance between sequential and simultaneous adrenal venous sampling in primary...

Area of Science:

• Endocrinology
• Interventional Radiology

Background:

• Accurate subtyping of primary aldosteronism (PA) is essential for treatment.
• Adrenal venous sampling (AVS) is the standard for PA subtyping.
• The optimal AVS technique (simultaneous vs. sequential) requires evaluation.

Purpose of the Study:

• To compare the diagnostic consistency of simultaneous and sequential bilateral AVS in PA patients.
• To evaluate the impact of sampling time on AVS accuracy.
• To determine the preferred AVS method for reliable PA subtyping.

Main Methods:

• Prospective enrollment of PA patients undergoing simultaneous bilateral unstimulated AVS.
• Blood samples collected from adrenal veins and peripheral vein at 0, 5, and 15 minutes.
• Sequential AVS simulated using different time points.
• Analysis of cortisol, aldosterone, selectivity index (SI), and lateralization index (LI).
• Diagnostic concordance assessed using ICC and Kappa statistics.

Main Results:

• Simultaneous AVS showed excellent agreement for LI across different time points (ICC=0.840).
• Lower agreement was found between simultaneous and simulated sequential AVS (ICC=0.680-0.707).
• Simultaneous AVS at a 5-minute interval demonstrated superior concordance (85.5% agreement, Kappa=0.768).
• Sequential AVS introduced bias in LI estimates, particularly in unilateral PA cases.
• Poor concordance was noted in patients with bilateral PA.

Conclusions:

• Simultaneous AVS provides better diagnostic consistency and precision for PA subtyping.
• Sequential AVS may be biased by temporal cortisol fluctuations.
• Simultaneous AVS is the gold standard; sequential AVS is a fallback option.
• Careful consideration of AVS technique is vital for accurate PA management.