Ata Fateen, Ebrahim Y A Alsaud Arwa, Ibrahim Rahil Ali, F Elhaj Maab, Elmudathir Osman Ahmed, Samir Mansour Shafik, J H Elhissi Mohammad, Elmagdoub Ayman, Bint I Bilal Ammara, Ahmed Baagar Khaled
Department of Endocrinology, Hamad Medical Corporation, Doha, Qatar.
Department of Internal Medicine, Hamad Medical Corporation, Doha, Qatar.
Ann Med. 2025 Dec;57(1):2548973. doi: 10.1080/07853890.2025.2548973. Epub 2025 Aug 22.
Adrenal vein sampling (AVS) is the gold standard for lateralizing aldosterone secretion in primary aldosteronism (PA) management. However, due to challenges in expertise and infrastructure, it remains underutilized in the Middle East (ME).
This study aimed to document the performance and outcomes of AVS in the ME.
This retrospective study included patients with PA who underwent AVS at a tertiary care hospital in Qatar (2015 - 2024). Clinical, biochemical, imaging and procedural data were collected to evaluate AVS success rates, imaging-AVS concordance and treatment outcomes. AVS success was defined as correct bilateral adrenal vein cannulation, determined by selectivity indices (unstimulated SI ≥ 2 or cosyntropin-stimulated SI ≥ 5).
The cohort ( = 31) had a mean age of 50.29 ± 8.19 years, with a male predominance (67.7%). AVS was successful in 71% ( = 22). There was a 59% concordance between AVS and adrenal imaging. Of those with successful AVS ( = 22), adrenalectomy was performed in 54.5% of patients, with 66.7% requiring fewer antihypertensives than pre-AVS. Pre-AVS hypokalemia resolved in 75% of patients undergoing AVS-guided adrenalectomies 20% in the medically managed group.
This study is the first to demonstrate AVS's safety and efficacy in the ME, achieving a 71% success rate. With an AVS-imaging concordance of only 59%, the study highlights the clinical significance of AVS in guiding optimal management decisions. AVS-directed interventions lead to better treatment strategies with high post-treatment cure rates. The role of technology, such as intraprocedural dynaCT, is reinforced in improving procedural accuracy.
肾上腺静脉采血（AVS）是原发性醛固酮增多症（PA）管理中醛固酮分泌侧别诊断的金标准。然而，由于专业知识和基础设施方面的挑战，它在中东地区（ME）的应用仍然不足。
本研究旨在记录中东地区AVS的操作情况和结果。
这项回顾性研究纳入了在卡塔尔一家三级护理医院接受AVS的PA患者（2015 - 2024年）。收集临床、生化、影像学和操作数据，以评估AVS成功率、影像学与AVS的一致性以及治疗结果。AVS成功定义为双侧肾上腺静脉插管正确，由选择性指数确定（基础状态下选择性指数≥2或促肾上腺皮质激素刺激后选择性指数≥5）。
该队列（n = 31）的平均年龄为50.29±8.19岁，男性占主导（67.7%）。AVS成功率为71%（n = 22）。AVS与肾上腺影像学之间的一致性为59%。在AVS成功的患者（n = 22）中，54.5%的患者接受了肾上腺切除术，66.7%的患者所需降压药比AVS前减少。在接受AVS引导下肾上腺切除术的患者中，75%的患者术前低钾血症得到缓解，而药物治疗组为20%。
本研究首次证明了AVS在中东地区的安全性和有效性，成功率达到71%。AVS与影像学的一致性仅为59%，该研究突出了AVS在指导最佳管理决策方面的临床意义。AVS指导的干预措施可带来更好的治疗策略，治疗后治愈率高。术中动态CT等技术在提高操作准确性方面的作用得到了加强。
