Adrenal Venous Sampling in the Investigation of Hyperaldosteronism: A Retrospective Practice Review from a Large Academic Medical Center.

Background: Hyperaldosteronism involves complex, multidisciplinary management, including clinical testing, radiological exams, and adrenal venous sampling (AVS). This study assesses AVS outcomes at a large referral center, focusing on cannulation success, lateralization of aldosterone-producing adenomas, and correlation with radiological and surgical findings.

Methods: A retrospective review of 153 patients who underwent AVS from September 2016 to January 2024 was conducted. Data included aldosterone and cortisol levels, procedural details, and outcomes. AVS success was determined by aldosterone-to-cortisol ratios and cortisol levels confirming adequate cannulation.

Results: Of the 153 patients, 49.9% had lateralized adenomas (51.3% left, 48.7% right), while 39.9% had bilateral adrenal hyperplasia. In 10.8% of cases, AVS was inconclusive or unsuccessful. Right adrenal vein cannulation required more attempts due to anatomical challenges. Aldosterone levels were higher in right adrenal adenomas compared to left, though cortisol levels did not predict laterality or hyperplasia. There was strong concordance between AVS, radiological, and surgical findings, except for bilateral hyperplasia cases.

Conclusions: This large series highlights AVS's central role in diagnosing hyperaldosteronism, with significant insights into cannulation challenges and biochemical correlations. The study underscores the importance of a multidisciplinary approach for accurate diagnosis and effective management.