Sawyer Matthew P, Yong Eric X Z, Marginson Benjamin, Farrell Stephen G, Derbyshire Maresa M, MacIsaac Richard J, Sachithanandan Nirupa
Department of Endocrinology & Diabetes, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia.
Department of Radiology, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia.
ANZ J Surg. 2022 Mar;92(3):437-442. doi: 10.1111/ans.17352. Epub 2021 Nov 21.
Adrenal vein sampling (AVS) is integral to identifying surgically remediable unilateral primary aldosteronism (PA). However, right adrenal vein (AV) cannulation can be challenging, limiting its success. Intra-procedural cortisol assays can improve the reliability of AVS. The aim of this study was to validate the use of semi-quantitative cortisol estimates obtained utilizing a quick cortisol assay (QCA) during AVS procedures at our institution.
Retrospective review of results of AVS procedures before and after the introduction of the QCA. Twenty-three AVS procedures were performed with the provisional success determined by intra-procedural QCA. Successful AV cannulation was defined by an AV to peripheral vein cortisol ratio ≥ 4.0 (the selectivity index) from laboratory measurements. The control cohort consisted of 23 consecutive procedures prior to introduction of the QCA.
QCA correctly predicted all AV cannulation attempts. Successful bilateral AV cannulation increased from 52% to 91% of procedures when performed with the QCA (P = 0.01) and adequate cannulation of the right AV increased from 61% to 91% (P = 0.03). There was no increase in procedural time, number of AV cannulation or sampling attempts.
Point-of-care, semi-quantitative cortisol estimates can be performed accurately during AVS with QCA, facilitating improvements in AVS success rates without increasing procedural time.
肾上腺静脉采血（AVS）对于识别可通过手术治疗的单侧原发性醛固酮增多症（PA）至关重要。然而，右侧肾上腺静脉（AV）插管可能具有挑战性，限制了其成功率。术中皮质醇检测可提高AVS的可靠性。本研究的目的是验证在我们机构的AVS程序中使用快速皮质醇检测（QCA）获得的半定量皮质醇估计值的实用性。
回顾性分析引入QCA前后AVS程序的结果。进行了23例AVS程序，术中QCA确定初步成功。成功的AV插管定义为实验室测量的AV与外周静脉皮质醇比值≥4.0（选择性指数）。对照组由引入QCA之前的23例连续程序组成。
QCA正确预测了所有AV插管尝试。使用QCA进行操作时，成功的双侧AV插管从程序的52%增加到91%（P = 0.01），右侧AV的充分插管从61%增加到91%（P = 0.03）。操作时间、AV插管或采样尝试次数没有增加。
在AVS期间使用QCA可以准确地进行即时半定量皮质醇估计值，有助于提高AVS成功率，而不增加操作时间。
