Endocrine Abstracts

JOINT3334

Purpose: Primary aldosteronism (PA) is the leading cause of endocrine hypertension. Adrenal vein sampling (AVS) is the recommended technique in lateralising PA to distinguish unilateral from bilateral disease. The success of AVS guides clinicians in making informed decisions to manage and treat PA effectively. Successful AVS requires a technically-skilled and experienced interventional radiologist and global success rates vary between 41.1% and 99.2%. The aim of this study was to assess the success rate of AVS by a single operator in a single centre.

Methods: A retrospective, single-centre study of AVS procedures performed by a single operator between January 2020 and January 2025. Aldosterone and cortisol levels were measured on samples collected from the right and left adrenal veins and low inferior vena cava (IVC). Successful adrenal vein cannulation was defined as selectivity index (SI) >3 with adrenocorticotropic hormone (ACTH) stimulation (n=110), and SI >2 without ACTH stimulation (n=2).

Results: A total of 112 patients underwent AVS: 70 (62.5%) were men and 42 (37.5%) were women, with a mean age of 52 years (range 27–74). Bilateral adrenal vein cannulation was achieved in 103 of 112 (91.96%) AVS procedures. In patients in whom bilateral cannulation was not achieved, this was due to an inability to sample the right adrenal vein in all nine patients. In addition, two patients who had previously undergone adrenal/para-adrenal surgery on the left also underwent AVS, with successful cannulation of the right adrenal vein, but the left adrenal could not be located (likely consequent on the previous surgery).

Conclusion: We have shown that adopting a standardised approach to AVS with a single experienced operator can deliver high rates of technically successful procedures. Our findings are therefore consistent with earlier published series and support the case for concentrating delivery of AVS in high volume specialist referral centres.