PS-C21-7: IMPACT OF THE TIME OF DAY PERFORMING AVS ON THE SUCCESS RATE AND SUBTYPE DIAGNOSIS IN PRIMARY ALDOSTERONISM

Abstract

Purpose: Adrenal vein sampling (AVS) is the gold-standard technique for the subtype diagnosis of primary aldosteronism (PA). Measurements of aldosterone and cortisol in adrenal venous blood are used to determine the success or failure of AVS and to diagnose the PA subtype, but these hormone secretions show diurnal change. In this study, we examined the effect of the time of AVS on the results. Design: Multicenter, retrospective, observational study Setting: Three centers in Japan Patients: 591 patients diagnosed with PA and undergoing AVS at 3 centers were used. All patients underwent basal AVS and ACTH-stimulated AVS on the same day. 382 patients underwent AVS in the morning (AM-AVS) and 209 patients in the afternoon (PM-AVS). Results: In terms of Selectivity Index (SI) in AVS, there was no significant difference in the right adrenal vein in basal AVS (22 vs. 23, p = 0.26), but SI of AM-AVS group was significantly higher in the left adrenal vein (19 vs. 17, p = 0.03). 03) than PM-AVS. However, in AVS after ACTH loading, SIs of both right and left adrenal veins were significantly higher in the PM group (Right: 42 vs. 44, p = 0.03; Left: 48 vs. 50, p = 0.01). However, there was no significant difference in AVS success rates between the two groups for basal AVS (81% vs. 74%, p = 0.08) and ACTH-stimulated AVS (92% vs. 88%, p = 0.19). There was also no significant difference in the proportion of patients diagnosed with unilateral PA in basal AVS (57% vs. 48%, p = 0.09) and ACTH-stimulated AVS (17% vs. 14%, p = 0.41). Conclusions: In a multicenter observational study, there was no significant difference in AVS success rate or subtype diagnosis of AVS between the different AVS times.