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. 2025 Jan 17:15:1497787.
doi: 10.3389/fendo.2024.1497787. eCollection 2024.

A clinical decision model for failed adrenal vein sampling in primary aldosteronism

Sophie N M Ter Haar #  1 , Sofie J van Goor #  1 , Eleonora P M Corssmit  1 , Arian R van Erkel  2 , Bartholomeus E P B Ballieux  3 , Olaf M Dekkers  1   4 , Michiel F Nijhoff  1
Affiliations

A clinical decision model for failed adrenal vein sampling in primary aldosteronism

Sophie N M Ter Haar et al. Front Endocrinol (Lausanne). .

Abstract

Objective: Primary aldosteronism (PA) is a common cause of secondary hypertension with unilateral and bilateral subtypes requiring different treatments. Adrenal vein sampling (AVS) is the gold standard for subtype differentiation but can be unsuccessful by challenging right adrenal vein anatomy. This study aimed to develop a clinical decision model using only measurements from the left adrenal vein (LAV) and peripheral blood (IVC) to differentiate between PA subtypes.

Methods: The retrospective cohort study included 54 PA patients who underwent bilaterally successful AVS. The main objective was to determine optimal cut-off values for the LAV/IVC index, using ROC analysis for subtype prediction. The predictive value of this index was assessed with the Area Under the Curve (AUC). The Youden index calculated cut-off values, targeting a specificity >90% for PA subtype differentiation.

Results: The cohort, averaging 48.5 ± 9.5 years in age, comprised 21 women and 33 men, among whom 26 presented with unilateral and 28 with bilateral disease. LAV/IVC values <1.2 indicated unilateral right-sided disease (specificity 91%, sensitivity 96%, AUC 0.98, 95% confidence interval (CI) 0.95-1.0), values 1.2-2.4 suggested bilateral disease (sensitivity 93%, specificity 64%, AUC 0.85, CI 0.73-0.96), whereas values ≥4.4 predicted unilateral left-sided disease (specificity 93%, sensitivity 60%, AUC 0.85, CI 0.73-0.96). Published literature aligns with our results on cut-off values.

Conclusions: Utilizing the LAV/IVC index, over 70% of unsuccessful AVS procedures due to failed right adrenal cannulation could be interpreted with over 90% certainty regarding the PA subtype, preventing unnecessary resampling and aiding in determining the preferred treatment.

Keywords: LAV/IVC index; adrenal vein sampling; adrenalectomy; disease subtype; failed right cannulation; primary aldosteronism.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Distribution of the A/C ratio and LAV/IVC index. A/C ratio distribution in the LAV according to disease subtype. Outliers from the unilateral left group (35.3, 41.4 and 47.9) are not displayed. Median A/C ratios (p<0.001); unilateral right 0.9, bilateral 3.8, unilateral left 10.6.B. LAV/IVC index, representing the A/C ratio between LAV and IVC, according to disease subtype. Outliers from the unilateral left group (9.7, 10.8 and 25.1) are not displayed. Median LAV/IVC index (p<0.001); unilateral right 0.6, bilateral 2.1, unilateral left 4.8. A/C, aldosterone/cortisol; LAV, left adrenal vein; IVC, inferior vena cava. * P < 0.001.
Figure 2
Figure 2
ROC curves of the A/C ratio and LAV/IVC index. ROC-curves of A/C and LAV/IVC cut-off values for (A). Unilateral left-sided disease; (B). Bilateral disease; (C). Unilateral right-sided disease. A/C, aldosterone/cortisol; LAV, left adrenal vein; IVC, inferior vena cava; AUC, area under the curve.
Figure 3
Figure 3
Clinical decision model. Treatment algorithm to interpret AVS sampling data of isolated successful left-sided sampling using the LAV/IVC index, based on specificity >90%. AVS, adrenal vein sampling; LAV, left adrenal vein; IVC, inferior vena cava.
See this image and copyright information in PMC

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