B Bouhanick1, M-C Delchier2, J Fauvel3, H Rousseau2, J Amar4, B Chamontin4. 1. Department of Internal Medicine and Hypertension, University Hospital Rangueil, TSA 50032, 31059 Toulouse cedex 9, France. Electronic address: duly-bouhanick.b@chu-toulouse.fr. 2. Department of Radiology, University Hospital Rangueil, 31059 Toulouse cedex 9, France. 3. Department of Biochemistry, institut fédératif de biologie, University Hospital Purpan, 31000 Toulouse, France. 4. Department of Internal Medicine and Hypertension, University Hospital Rangueil, TSA 50032, 31059 Toulouse cedex 9, France.
Abstract
UNLABELLED: Adrenal venous sampling (AVS) is a challenging technical procedure and few patients had AVS procedure twice. AIM: To evaluate the reproducibility of the AVS, why AVS were repeated and the conclusions drawn from them. PATIENTS AND METHODS: From 1997-2012, 12 patients underwent two AVS. A cortisol level in the adrenal vein greater than or equal to 1.1 to inferior vena cava defined a successful catheterization and a lateralization of secretion corresponded to an aldosterone-to-cortisol vein ratio greater than or equal to 2 between the one side to another. RESULTS: The same side of lateralization of secretion was found in 75% of them. The second AVS were due to technical failure (n=4), unproven lateralization (n=2), a lateralization opposite to the main nodule and ipsilateral to hyperplasia (n=4) on first AVS. For two patients, as the CT was normal, AVS was required again. The second AVS was successful in all patients, including those with an initial technical failure but only patient with technical failure underwent surgery, as BP and kaliemia were controlled. Lateralization on the side of hyperplasia or opposite to the biggest nodule was confirmed in two of four cases. CONCLUSION: When AVS is unsuccessful for technical reasons, it is worth doing it again but after being sure that surgery is still possibly indicated.
UNLABELLED: Adrenal venous sampling (AVS) is a challenging technical procedure and few patients had AVS procedure twice. AIM: To evaluate the reproducibility of the AVS, why AVS were repeated and the conclusions drawn from them. PATIENTS AND METHODS: From 1997-2012, 12 patients underwent two AVS. A cortisol level in the adrenal vein greater than or equal to 1.1 to inferior vena cava defined a successful catheterization and a lateralization of secretion corresponded to an aldosterone-to-cortisol vein ratio greater than or equal to 2 between the one side to another. RESULTS: The same side of lateralization of secretion was found in 75% of them. The second AVS were due to technical failure (n=4), unproven lateralization (n=2), a lateralization opposite to the main nodule and ipsilateral to hyperplasia (n=4) on first AVS. For two patients, as the CT was normal, AVS was required again. The second AVS was successful in all patients, including those with an initial technical failure but only patient with technical failure underwent surgery, as BP and kaliemia were controlled. Lateralization on the side of hyperplasia or opposite to the biggest nodule was confirmed in two of four cases. CONCLUSION: When AVS is unsuccessful for technical reasons, it is worth doing it again but after being sure that surgery is still possibly indicated.