Abstract 11798: Adrenal Vein Sampling for Identification of the Subtypes of Primary Aldosteronism: Results on 2635 Cases of the Avis Study
Objective. To identify the surgically curable causes of hyperaldosteronism the Endocrine Society Guidelines recommend using adrenal venous sampling (AVS). However, this recommendation remains poorly implemented in clinical practice because of fear of complications and lack of accepted criteria for interpretation of AVS. We therefore investigated how AVS is being performed and interpreted at major referral centers worldwide.
Methods. Eligible centers were identified through database search and invited to participate to the phase I of the AVIS Study, which was aimed at gathering summary data on clinical use of AVS.
Results. The study provided data on a total of 2635 AVS studies performed at 20 centers around the world in the last 6 years. It showed that AVS was systematically offered to patients with primary aldosteronism in 79.6% of the cases and that the rate of major complications (adrenal vein rupture) was tiny (0.6%). At regression (backward, Wald) analysis these complications were predicted by number of radiologists performing AVS (r=0.52; p<0.009) and number of AVS performed (r=0.415, p=0.034), but not by use of bilateral simultaneous vs sequential AVS technique, or by the Continent where the performing center was located. A model with these two predictors (F= 6.66, p=0.019) accounted for 23% of the variance of adrenal vein ruptures. For both the selectivity (SI) and the lateralization index (LI) there was a wide variability of cut-off values used for diagnosis: for the SI the cutoffs ranged between 1.1 and 3.0 under baseline condition and between 2.0 and 10.0 after ACTH stimulation. For the LI the cutoffs ranged from 2.0 to 5.0 under unstimulated conditions and between 2.0 and 4.0 after ACTH. Moreover, 10% of the centers still used absolute hormonal values instead of these indexes.
Conclusions. At most major referral centers worldwide AVS carries a minimal risk of adrenal vein rupture. Notwithstanding this and at variance with the guidelines recommendations, it is not systematically used. The persistent use of absolute hormonal values and of ACTH stimulation testifies the gap between improved knowledge and optimal implementation of use of AVS in clinical practice.
- © 2011 by American Heart Association, Inc.