Endocrine Abstracts (2017) 50 P010 | DOI: 10.1530/endoabs.50.P010

The impact of a point-of-care rapid cortisol assay on success rate, procedural efficiency and radiation dose in adrenal vein sampling for primary hyperaldosteronism

Safwaan Adam1,2,3, Julian Soares2, Ed Lake2, Caterina Del Col2, Allen Yates2, Peter Trainer1,3,4 & Nicholas Chalmers2,3

1University of Manchester, Manchester, UK; 2Central Manchester Hospitals NHS Foundation Trust, Manchester, UK; 3Manchester Academic Health Science Centre, Manchester, UK; 4The Christie NHS Foundation Trust, Manchester, UK.

Introduction: Catheterisation of the right adrenal vein when performing adrenal vein sampling (AVS) is challenging. The AVS Accuracy Kit (AAK) (Trust Medical, Kasai, Japan) enables point-of-care confirmation of accuracy of AVS by rapid cortisol assay. We investigated whether use of AAK during AVS would impact upon procedural success, number of venous samples taken, radiation dose and screening time.

Methods: 0.5 ml of each venous blood sample was centrifuged immediately and 0.1 ml of plasma applied to the AAK test strip and read at 3 min within the interventional radiology suite. A prospective series of 10 consecutive patients (single operator) undergoing AVS using AAK (AAK group) was compared to a retrospective series of 40 consecutive patients without AAK (nAKK group). We recorded procedural success (adrenal/peripheral cortisol ratio>2), number of venous samples taken, screening time and radiation dose.

Results: At first procedure, right AVS was technically successful in 32/40(80%) in the nAAK group compared to 9/10(90%) in the AAK group. Subsequent successful repeat procedures (separate occasion) were performed in 4 patients leading to a combined success rate in the nAAK group of 90% (36/40). Point-of-care cortisol estimations corroborated with laboratory cortisol measurements by immunoassay thus confirming accuracy. There were non-significant differences between groups in the number of venous samples and screening time per procedure (table). There was a significant reduction in the radiation dose-area-product per patient in the AAK group (table 1).

Table 1 Comparison between groups. Parametric data shown as mean (±S.D.) and non-parametric as median (IQR).
MeasurementnAAK groupAAK groupP
Age (years)56 (±13)52 (±13)0.39
Successful catherisation at first procedure (%)32/40 (80%)9/10 (90%)0.60
Number of right-sided venous samples per case (min–max)2 (1–7)2.5 (1–5)0.62
Number of left-sided venous samples per case (min–max)1 (1–3)1 (1–3)0.85
Radiation dose (μGym2)5383 (1944–9629)2107 (1598–4068)0.03
Screening time (minutes)12.1 (7.1–20.4)6.8 (4.3–17.6)0.12

Conclusion: The AAK can reduce the screening time and radiation dose during AVS. It may improve procedure success and reduce the need for repeat procedures although further confirmatory studies are needed.

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