Recent Advances in the Clinical Application of Adrenal Vein Sampling.

Shan Zhong,Xiaohong Xu,Zhenjie Liu,Xiaoxiao Song,Minzhi He,Tianyue Zhang,Zhongyi Li,Hanxiao Yu

doi:10.3389/fendo.2022.797021

Abstract

We reviewed clinical research investigating the applications of adrenal vein sampling (AVS). AVS could be applied not only to primary aldosteronism (PA) but also to other endocrine diseases, such as adrenocorticotropic hormone (ACTH) independent Cushing syndrome (AICS) and hyperandrogenemia (HA). However, the AVS protocol requires improvements to increase its success rate. Using the computed tomography image fusion, coaxial guidewire technique, and fast intraprocedural cortisol testing (CCF) technique could improve the success rate of catheterization in AVS for PA. ACTH loading could be considered in medical centers with a low selectivity of AVS for PA but is not essential in those with mature AVS technology. The continuous infusion method should be recommended for ACTH stimulation in AVS for PA to reduce adverse events. AVS has not been routinely recommended before management decisions in AICS, but several studies verified that AVS was useful in finding out the source of excess cortisol, especially for distinguishing unilateral from bilateral disease. However, it is necessary to reassess the results of AVS in AICS with the use of reference hormones to fully normalize cortisol levels. In addition, it is essential to determine the optimal model that combines AVS results and mass size to guide the selection of surgical plans, including identifying the dominant gland and presenting the option of staged adrenalectomy, to minimize the impact of bilateral resection. For HA, AVS combined with ovarian intravenous sampling to locate excess androgens could be considered when imaging results are equivocal.

Highlights

Adrenal vein sampling (AVS) was first developed in the 1960s [1]
adrenocorticotropic hormone (ACTH) loading could be considered in medical centers with a low selectivity of AVS, but it is not essential in those with mature AVS technology
It is essential to determine the optimal model that combines AVS results and mass size to guide the selection of surgical plans, to minimize the impact of bilateral resection

Summary

INTRODUCTION

Adrenal vein sampling (AVS) was first developed in the 1960s [1]. The most important and extensive use of AVS was its use as the gold standard method for localizing the overproduction of aldosterone in primary aldosteronism (PA) [2]. Despite AVS being the gold standard method and having high sensitivity and specificity for the diagnosis of different primary aldosteronism subtypes, it has varied success rates. Many studies focused on increasing the success rate of AVS, including successful right adrenal vein catheterization, the role of ACTH loading during AVS, and the evaluation index of the AVS results, which we have described below. A recent study at our center found that the Computed tomography image fusion, Coaxial guidewire technique, Fast intraprocedural cortisol testing (CCF) technique significantly improved technical success rates and reduced procedure time, radiation exposure, and contrast medium volume [7]. Since only 48 patients were included in the study, the reliability of AVS access via the forearm vein remained unclear Another viable method was using imaging to obtain an accurate visualization of the right adrenal vein, which was vital both before and during AVS. A large retrospective study conducted by Tekada et al, in 2019 compared the two techniques

Limitations

37 Patients with PA

CONCLUSIONS