Related Experiment Video
Updated: Jun 28, 2026

A Novel Method: Super-selective Adrenal Venous Sampling
Published on: September 15, 2017
Sampling variability and concordance between sequential and simultaneous adrenal venous sampling in primary
Shaomin Shi1, Luhong Li1, Shuangyu Shen1
1Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, 139 JingzhouStreet, Xiangyang, Hubei 441000, China.
Objective:
Accurate subtyping of primary aldosteronism (PA) via adrenal venous sampling (AVS) is pivotal for guiding treatment decisions. However, the optimal AVS approach-simultaneous versus sequential bilateral sampling-remains controversial, necessitating a rigorous evaluation of diagnostic consistency between these 2 techniques.
Methods:
Consecutive PA patients who underwent bilateral simultaneous unstimulated AVS via the antecubital vein between December 2024 and January 2026 were prospectively enrolled. Blood samples were collected from the bilateral adrenal veins and a peripheral vein at baseline (t0), 5 min (t5), and 15 min (t15) after catheterization. Sequential AVS was simulated by sampling the right adrenal vein (RAV) at t0 and the left adrenal vein (LAV) at either t5 or t15. Cortisol and aldosterone concentrations, the selectivity index, and the lateralization index (LI) were measured for all samples. Diagnostic concordance between sampling approaches was assessed using the intraclass correlation coefficient (ICC) and Kappa statistics.
Results:
A total of 55 eligible patients were included in the final analysis. Cortisol levels exhibited a significant gradual decline over time (P < .05 for t0 vs. t5), with substantial temporal variability in LI observed throughout the sampling process. ICC analysis demonstrated excellent agreement for LI among simultaneous AVS measurements at different time points (ICC = 0.840, 95% CI: 0.764-0.895), whereas agreement was lower between simultaneous and simulated sequential AVS (ICC = 0.680, 95% CI: 0.593-0.756 for t5 vs. t0-t5; ICC = 0.707, 95% CI: 0.560-0.820 for t15 vs. t0-t15). Kappa statistics confirmed superior diagnostic concordance for simultaneous AVS at a 5-min interval (agreement = 85.5%, Kappa = 0.768) compared with longer sampling intervals or sequential AVS, with notably poor concordance observed in patients with bilateral PA. Sequential AVS showed systematic differences in LI estimates, with underestimation in right-dominant unilateral PA and overestimation in left-dominant UPA.
Conclusions:
Sequential AVS may be subject to bias due to stress-related cortisol changes over time, whereas simultaneous AVS provides better diagnostic concordance. Simultaneous AVS remains the gold standard for optimal precision, though sequential AVS is a viable alternative when simultaneous cannulation is not possible.
Related Concept Videos
Adrenal Gland Disorders
Adrenal insufficiency, characterized by insufficient cortisol and aldosterone production, leads to conditions like Addison's disease. This disorder, affecting the adrenal cortex, exhibits symptoms such as skin bronzing, dehydration, low blood pressure, fatigue, and weight loss. Congenital adrenal hyperplasia, a genetic ailment causing...
Hypertension III: Clinical Manifestations and Diagnostic Studies
Anatomy of the Adrenal Glands
These glands possess a distinctive yellow tinge due to the stored cholesterol and fatty acids required for hormone synthesis. They are encased in a fibrous capsule and cushioned by fat.
The adrenal gland comprises two distinct regions...
Acute Coronary Syndrome III: Diagnostic Studies
Assessment of blood pressure in brachial artery(two-step method)
Adrenergic Receptors: ɑ Subtype
Adrenaline ≥ Noradrenaline >> Isoprenaline
α-adrenoceptors are further divided into α1 and α2-adrenoceptors.
α1-Adrenoceptors: These receptors are located postsynaptically on the effector organs and cause constriction of smooth muscle mediated by activation of phospholipase C—inositol-1,4,5-trisphosphate...
