Michael Anthony Reardon BS, Presenter: Nothing to Disclose

John F. Angle MD, Abstract Co-Author: Research grant, Atrium Medical Corporation Speaker, Siemens AG Consultant, AGA Medical Corp

Nadine Abi-Jaoudeh, Abstract Co-Author: Nothing to Disclose

Robert M Carey MD, Abstract Co-Author: Nothing to Disclose

David E Bruns MD, Abstract Co-Author: Nothing to Disclose

Alan Hiyoshi Matsumoto MD, Abstract Co-Author: Speakers Bureau, W. L. Gore & Associates, Inc Speakers Bureau, Cook Group, Inc Speakers Bureau, Medtronic, Inc Advisory Board, Crux Biomedical, Inc Research grant, Talecris Biotherapeutics, Inc Research grant, Medtronic, Inc Research grant, W. L. Gore & Associates, Inc Research grant, Cook Group Incorporated Research grant, Siemens AG Consultant, Siemens AG Consultant, C. R. Bard, Inc Consultant, AGA Medical Corp Data Monitoring Safety Board, CH-Werfen

Adrenal venous sampling (AVS) is a clinically important procedure which is limited by occasional technical failures due to errors in catheter position or sampling. These inadequate samples are often not recognized at the time of the procedure and can lead to non-diagnostic results. Intra-procedural evaluation of cortisol levels obtained from the adrenal and peripheral veins provides confirmation that the samples are adequate prior to leaving the procedure room. We report on our institution’s use of stat cortisol levels to increase the diagnostic yield of AVS in the evaluation of primary hyperaldosteronism (PA).

A retrospective review of 46 AVS procedures performed on 43 patients with PA. Stat intra-procedural cortisol levels were available during the 10 most recent patient evaluations within twenty minutes of starting the case. Catheterization was considered successful if the adrenal vein/peripheral vein cortisol ratio for both right and left adrenals at a single time point was greater than 2:1 prior to ACTH (cortrosyn) administration or greater than 5:1 post cortrosyn administration.

7 of the 36 (19.4%) AVS procedures performed prior to the use of stat cortisol levels were technical failures based on the cortisol ratios. Three of these 7 patients underwent an additional AVS procedure which was technically successful in 3/3 (100.0%). All 10 (100%) of the procedures were technically successful after the institution of stat cortisol levels. Of note, in 3 of the 10 cases (30%), the operators repositioned the right or left catheter because initial cortisol results suggested inadequate sampling and no patients needed repeated AVS procedures.

Intra-procedure cortisol level reporting increases the likelihood that adequate sampling is obtained. Using this methodology may reduce the need for repeat AVS procedures.

To improve the technical success of adrenal venous sampling in the evaluation of patients with primary hyperaldosteronism

Reardon, M, Angle, J, Abi-Jaoudeh, N, Carey, R, Bruns, D, Matsumoto, A, Stat Cortisol Levels to Ensure Proper Catheter Placement in Adrenal Venous Sampling for the Evaluation of Primary Hyperaldosteronism.  Radiological Society of North America 2008 Scientific Assembly and Annual Meeting, February 18 - February 20, 2008 ,Chicago IL. http://archive.rsna.org/2008/6017235.html