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Surgery. 2016 Jan;159(1):267-73. doi: 10.1016/j.surg.2015.06.048. Epub 2015 Oct 2.

Diagnostic utility of data from adrenal venous sampling for primary aldosteronism despite failed cannulation of the right adrenal vein.

Author information

1
Endocrine Surgery Section, Department of Surgery, University of California, San Francisco, CA.
2
Endocrine Surgery Section, Department of Surgery, Columbia University, New York, NY.
3
Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA.
4
Endocrine Surgery Section, Department of Surgery, University of California, San Francisco, CA. Electronic address: Insoo.suh@ucsf.edu.

Abstract

BACKGROUND:

Adrenal venous sampling is an important lateralization study for primary aldosteronism, but inability to cannulate the right adrenal vein is not uncommon and interpreted as a failed study. We challenged this notion by examining whether data from incomplete left-sided adrenal venous sampling could accurately predict lateralization.

METHODS:

Sixty-two adrenal venous sampling studies from 2007 to 2014 at 2 tertiary-care institutions were reviewed. For this analysis, data from the right adrenal vein were excluded. The study variable was the aldosterone:cortisol ratio of the left adrenal vein compared with the inferior vena cava (LAV/IVC). Scatterplot analysis identified high and low LAV/IVC cutoffs that predicted accurately unilateral disease in 1 institutional cohort and validated in the second cohort.

RESULTS:

Thirty-six studies of adrenal venous sampling were evaluated at the first institution and divided into 3 diagnostic categories: unilateral-left (n = 14), unilateral-right (n = 12), and bilateral (n = 10). Cutoff values of the ratios of LAV/IVC of ≥ 5.5 and ≤ 0.5 accurately predicted left- and right-sided disease, respectively, and were validated in 26 studies from the second institution (100% PPV). The "5.5-0.5 criteria" salvaged accuracy for predicting lateralization in 50% of cases.

CONCLUSION:

Even in the setting of failed cannulation of the right adrenal vein, the actual data from the remaining adrenal venous sampling can predict lateralization accurately in many patients. A "failed" adrenal venous sampling study may be of greater predictive utility than believed traditionally.

Comment in

PMID:
26435431
DOI:
10.1016/j.surg.2015.06.048
[Indexed for MEDLINE]

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