Abstract
Primary aldosteronism (PA) is a common cause of secondary hypertension and is caused by unilateral or bilateral adrenal disease. Treatment options depend on whether the disease is lateralized or not, which is preferably evaluated with selective adrenal venous sampling (AVS). This procedure is technically challenging, and obtaining representative samples from the adrenal veins can prove difficult. Unsuccessful AVS procedures often require reexamination. Analysis of cortisol during the procedure may enhance the success rate. We invited 21 consecutive patients to participate in a study with intra-procedural point of care cortisol analysis. When this assay showed nonrepresentative sampling, new samples were drawn after redirection of the catheter. The study patients were compared using the 21 previous procedures. The intra-procedural cortisol assay increased the success rate from 10/21 patients in the historical cohort to 17/21 patients in the study group. In four of the 17 successful procedures, repeated samples needed to be drawn. Successful sampling at first attempt improved from the first seven to the last seven study patients. Point of care cortisol analysis during AVS improves success rate and reduces the need for reexaminations, in accordance with previous studies. Successful AVS is crucial when deciding which patients with PA will benefit from surgical treatment.
Highlights
Primary aldosteronism (PA) is a common cause of secondary hypertension; the prevalence is 2–15% in selected cohorts of hypertensive patients [1, 2, 3, 4, 5]
We found that after implementation of intra-procedural point of care cortisol analysis, the success rate of adrenal venous sampling (AVS) procedures increased from 48% in the control period to
This was due to an increase in the success rate of right AVS
Summary
Primary aldosteronism (PA) is a common cause of secondary hypertension; the prevalence is 2–15% in selected cohorts of hypertensive patients [1, 2, 3, 4, 5]. Patients with PA have higher cardiovascular mortality and morbidity than controls with essential hypertension, possibly due to the presence of mineralocorticoid receptors in the heart and large vessels [2, 6]. In w30–50% of the patients, the disease is unilateral, caused by for instance aldosterone-secreting adenomas, whereas the rest have bilateral disease [2, 6, 7, 8]. Most patients with unilateral adenomas are either cured or have significant improvement of their hypertension after adrenalectomy [9]. If the adrenal hypersecretion of aldosterone is bilateral, or a patient is unwilling to undergo surgery, medical treatment with a mineralocorticoid receptor antagonist is recommended [10]
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