Effectiveness of Adrenal Venous Sampling in the Management of Primary Aldosteronism: Single-Centered Cross-Sectional Study at a Tertiary Care Hospital in Sri Lanka.

Abstract

Introduction: Adrenal venous sampling (AVS) is the gold standard procedure to discriminate unilateral primary aldosteronism (UPA) from bilateral disease (BPA). AVS is technically demanding and is only performed in a limited number of centers in Sri Lanka. This study aimed to evaluate the effectiveness of AVS in the management of primary aldosteronism.

Methodology: Thirty-two patients who underwent AVS at the National Hospital of Sri Lanka from April 2021 to April 2023 were enrolled. Continuous and categorical variables were summarized with mean ± SD and proportions, respectively. Mean and standard deviation of contralateral suppression index (CSI) were estimated with an intercept-only Bayesian inference model.

Results: The adrenal veins were successfully cannulated in 12 (37.5%). Lateralization was established in 11 (91.7%), and one was diagnosed as having bilateral disease. There were no total failures. Right AV cannulation was unsuccessful in 18 (56.25%), out of which lateralization was demonstrated in 9 (50%), while the rest were considered inconclusive. Left AV cannulation was unsuccessful only in 2 (6.25%); one was lateralized, while the other remained inconclusive. Among patients classified as having unilateral disease, the estimated mean of the CSI was 0.33 (89% credible interval: 0.11-0.86).

Conclusion: Despite failure due to procedural difficulties, AVS remained useful in the management of patients with PA. CSI remains a useful tool when cannulation is unsuccessful, especially on the right side.