Adrenal vein sampling: accuracy of earlier sampling post adrenocorticotropic hormone (ACTH) administration

Abstract

Aim

Multiple studies recommend sampling at least 15-30-minutes post administration of ACTH. The aim of this retrospective study was to determine the impact on adrenal vein sampling (AVS) result interpretation when obtaining post-ACTH blood samples earlier, at 5- and 10-minutes, compared to the standard 15-30 minutes.

Materials and methods

All consecutive adult patients who underwent AVS using the simultaneous sampling method between August 2023 and March 2024 were included. The differences in adrenal vein aldosterone and cortisol levels at 5- and 10-minutes were compared to the referenced 15-minute samples.

Results

A total of 46 AVS studies were included. On average, there was an 11- and 9-fold increase in the SI between the pre- and post-ACTH samples on the right and left respectively, indicating appropriate adrenal vein cannulation. Most of the percentage differences between the levels of cortisol and aldosterone at 5- and 10-minutes compared to those at 15-minutes were within 1 standard deviation from the median. There was no significant difference in LI or overall lateralisation between the 5-minute (paired t-test P = 0.18) and the 10-minute sample (paired t-test P = 0.61) compared to the 15-minute sample. The LI at 5-minutes and 10 minutes demonstrated strong correlation with that at 15-minutes. There was one exception where the LI of the 5- and 10-minute samples were discordant with the 15-minute sample, but concordant with the pre-ACTH sample.

Conclusion

AVS can be a lengthy and technically challenging procedure. Being able to sample much earlier post-ACTH may help improve procedural efficiency, reduce procedural risks and minimize patient discomfort.