Adrenal venous sampling: Indications and technical challenges

Adrenal venous catheterisation is a procedure used in the aetiological diagnosis of primary aldosteronism (PA). Its purpose is to measure aldosterone and cortisol levels in blood samples obtained from both adrenal veins and compare them with peripheral levels, allowing for the identification of potential lateralisation in hormone secretion. Owing to its high sensitivity and specificity, it is a key-though technically demanding-technique that should be performed in specialised centres. Accurate diagnosis leads to better clinical outcomes by avoiding unnecessary surgical interventions. The aim of this article is to review the anatomy and anatomical variants of the adrenal glands and their venous drainage, with a focus on describing the catheterisation technique. This procedure involves multiple technical challenges that can affect the accurate collection of samples and interpretation of results. These difficulties justify the need for a detailed review to help optimise the procedure and improve its success rate.