Adrenal Vein Sampling Parameters in Non–ACTH-Stimulated and ACTH-Stimulated Groups That Underwent Successful Procedures
inferior vena cava blood, adrenal adenoma, non-ACTH, adrenal vein blood, inferior vena cava
ADRENAL ADENOMA
Abbreviations: ACTH, corticotropin; AV, adrenal vein; IVC, inferior vena cava; IVC1, inferior vena cava blood collected immediately after the collection of left adrenal vein blood; IVC2, inferior vena cava blood collected immediately after the collection of right adrenal vein blood; MRA, mineralocorticoid receptor antagonist; PAC, plasma aldosterone concentration; PCC, plasma cortisol concentration.SI conversion factors: To convert plasma aldosterone to pmol/L, multiply by 27.74; plasma renin to pmol/L, multiply by 0.0237; and plasma cortisol to nmol/L, multiply by 27.588.Patients with failed AVS were excluded (9 in the non–ACTH-stimulated and 8 in the ACTH-stimulated group).Data are expressed as the median (IQR).In the non-ACTH group, 9 of 115 patients (7.8%) had failed cannulation (5 [55.6%] of the right and 4 [44.4%] of the left adrenal vein). Of the 106 successful procedures, 70 (66.0%) showed lateralization of aldosterone production (64 [91.4%] with an LI > 4 and 6 [8.6%] with an LI of 2-4 plus contralateral suppression), 31 (29.2%) showed no lateralization, and 5 (4.7%) were considered inconclusive due to a lower PAC-PCC ratio in bilateral adrenal veins compared with the peripheral vein. All 31 patients who were diagnosed with BPA by AVS were treated with MRA, while 65 of the 70 who were diagnosed with UPA by AVS (92.9%) underwent adrenalectomy. Five of the patients with UPA (7.1%) declined surgery and chose MRA treatment. One of the 5 patients with inconclusive AVS results (20.0%) met the criteria for surgery according to the prespecified study protocol and underwent adrenalectomy, and the other 4 (80.0%) were treated with MRA. Among the 9 patients with unsuccessful AVS procedures, 1 (11.1%) met criteria for surgery, 1 (11.1%) requested surgery by herself and underwent adrenalectomy, and the other 7 (77.8%) were treated with MRA.In the ACTH group, 8 of the 113 procedures (7.1%) were unsuccessful due to failed cannulation of the right adrenal vein. In the 105 successful procedures, 64 (61.0%) showed lateralization of aldosterone production (60 [93.8%] had an LI > 4, 2 [3.1%] had an LI of 2-4 plus contralateral suppression, and 2 [3.1%] had an LI of 2-4 plus adrenal adenoma on CT), 39 (37.1%) showed no lateralization, and 2 (1.9%) were considered inconclusive due to a lower PAC-PCC ratio in the bilateral adrenal veins than the peripheral vein. All 39 patients who were diagnosed with BPA by AVS were treated with MRA, and 59 of the 64 who were diagnosed with UPA by AVS underwent adrenalectomy (92.2%), while 5 patients (7.8%) with UPA chose MRA treatment. One of the 2 patients (50.0%) with inconclusive AVS results met the criteria for surgery according to prespecified study protocol and underwent adrenalectomy, while the other was treated with MRA. Among the 8 patients with unsuccessful AVS procedures, 4 (50.0%) met the criteria for surgery, whereas 1 (12.5%) requested surgery and hence underwent adrenalectomy and 3 (37.5%) were treated with MRA.