Calculated Right Adrenal Vein Aldosterone Levels in Patients Undergoing Adrenal Vein Sampling: The Potential to Lateralize Despite Unsuccessful Selection of the Right Adrenal Vein

Lalita Tuandam; Supamai Soonthornpun

doi:10.1016/j.jvir.2024.07.024

Calculated Right Adrenal Vein Aldosterone Levels in Patients Undergoing Adrenal Vein Sampling: The Potential to Lateralize Despite Unsuccessful Selection of the Right Adrenal Vein

J Vasc Interv Radiol. 2024 Aug 2:S1051-0443(24)00499-8. doi: 10.1016/j.jvir.2024.07.024. Online ahead of print.

Authors

Lalita Tuandam¹, Supamai Soonthornpun²

Affiliations

¹ Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand.
² Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand. Electronic address: ssupamai@hotmail.com.

PMID: 39097226
DOI: 10.1016/j.jvir.2024.07.024

Abstract

Purpose: The aim of this study was to use calculated aldosterone level in the right adrenal vein (RAV) (cAldo_RAV) rather than measured level for identifying the dominant side of aldosterone secretion in patients with primary aldosteronism undergoing adrenocorticotropic hormone-stimulated adrenal venous sampling (AVS).

Materials and methods: Patients with primary aldosteronism who had successful AVS (selectivity index, >3) were studied. Based on the assumption that cortisol production from both adrenal glands is equal, aldosterone level in the RAV was calculated using the data from the left adrenal vein and inferior vena cava. The aldosterone level in the left adrenal vein (Aldo_LAV) compared with the cAldo_RAV (Aldo_LAV:cAldo_RAV ratio) was then used to determine the dominant side of aldosterone secretion compared with standard AVS interpretation using lateralization index (LI). LI ≥4 indicated unilateral disease, and LI ≤3 indicated bilateral disease. The LI between 3 and 4 was diagnosed as indeterminate.

Results: Sixty-eight patients with concordant results between AVS and adrenal imaging study (32 were left-sided, 22 were right-sided, and 14 were bilateral) were selected for studying diagnostic performance. The Aldo_LAV:cAldo_RAV ratio with the cutoff values of ≥3 and ≤0.33 could identify unilateral diseases (left-sided and right-sided disease, respectively) with 92.6% sensitivity and 100% specificity.

Conclusions: The calculated Aldo_LAV:cAldo_RAV ratio can determine the dominant side of aldosterone secretion with high sensitivity and specificity when compared with standard AVS interpretation of measured levels. It provides an option for identification of unilateral and bilateral disease in select patients in whom right adrenal vein selection is unsuccessful.