Division of Endocrinology, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada.
J Clin Endocrinol Metab. 2021 Mar 8;106(3):e1170-e1178. doi: 10.1210/clinem/dgaa930.
The reproducibility of adrenal vein sampling (AVS) is unknown.
This work aimed to determine reproducibility of biochemical results and diagnostic lateralization in patients undergoing repeat AVS.
A retrospective chart review was conducted of single-center, single-operator AVS procedures at a tertiary care center. Included were patients with confirmed primary aldosteronism (PA) undergoing repeat AVS because of concerns about technical success or discordant diagnostic results. Simultaneous AVS was performed by an experienced operator using a consistent protocol of precosyntropin and postcosyntropin infusion. Among successfully catheterized adrenal veins (selectivity index ≥ 2), the correlation of the adrenalaldosterone/cortisol (A/C) ratio was measured between the first and second AVS. The secondary outcome measure was diagnostic agreement on repeat AVS lateralization (lateralization index ≥ 3).
There were 46 sets of AVS from 23 patients at a median of 3 months apart. There was moderate correlation in A/C ratios in the adrenal veins and inferior vena cava (Spearman r = 0.49-0.59, P < .05) pre cosyntropin. Post cosyntropin, the correlation was better (Spearman r = 0.67-0.76, P < .05). In technically successful AVS, there was moderate correlation between the repeated lateralization indices (Spearman r = 0.53, P < .05). In 15 patients in whom repeat AVS was performed because of apparent lateralization discordance with computed tomography imaging, the final diagnosis was the same in the second AVS procedure. Initial failed AVS was successful 75% of the time on repeat attempt.
Repeat AVS was feasible and usually successful when an initial attempt failed. There was modest correlation between individual repeat adrenal A/C ratios and lateralization indices when AVS was performed twice. The final lateralization diagnosis was identical in all cases. This demonstrates that AVS is a reliable and reproducible localizing test in PA.
肾上腺静脉采样（AVS）的可重复性尚不清楚。
本研究旨在确定重复 AVS 患者的生化结果和诊断定位的可重复性。
对一家三级保健中心单中心、单操作者 AVS 手术进行回顾性图表审查。纳入标准为接受过复发性 AVS 的确诊原发性醛固酮增多症（PA）患者，原因是对技术成功或诊断结果不一致表示担忧。由一位经验丰富的操作者同时进行 AVS，使用一致的促皮质素预输注和后输注方案。在成功插管的肾上腺静脉中（选择性指数≥2），测量第一次和第二次 AVS 之间的肾上腺醛固酮/皮质醇（A/C）比值的相关性。次要终点测量是在重复 AVS 定位（定位指数≥3）上的诊断一致性。
在中位时间为 3 个月的间隔内，23 例患者共进行了 46 次 AVS。在预促皮质素时，肾上腺静脉和下腔静脉中的 A/C 比值有中度相关性（Spearman r=0.49-0.59，P<0.05）。在后促皮质素时，相关性更好（Spearman r=0.67-0.76，P<0.05）。在技术上成功的 AVS 中，重复的侧化指数之间有中度相关性（Spearman r=0.53，P<0.05）。在 15 例因与计算机断层成像术明显侧化不一致而重复进行 AVS 的患者中，第二次 AVS 手术的最终诊断相同。初次 AVS 失败后，再次尝试时成功率为 75%。
当初次尝试失败时，重复 AVS 是可行且通常是成功的。当进行两次 AVS 时，个体重复的肾上腺 A/C 比值和侧化指数之间存在适度的相关性。在所有情况下，最终的侧化诊断都是相同的。这表明 AVS 是一种可靠且可重复的 PA 定位试验。
