Our aims were to: examine the impact of a dedicated protocol on the success rates of AVS; assess the utility of ACTH stimulation in AVS; and evaluate the impact of AVS on the final subtype diagnosis of PA.
An audit was conducted on all AVS procedures performed between January 2005 and May 2014 at Monash Health. Clinical information was collected on: patient demographics, screening aldosterone and renin concentration, AVS aldosterone and cortisol levels pre- and post-ACTH stimulation, adrenal imaging, blood pressure and antihypertensive requirements.
The overall technical success rate of AVS procedures was 47% before (n = 17) and 65% (n= 24) after the implementation of the AVS protocol. ACTH-stimulation permitted lateralization in one patient, however, it incorrectly obscured lateralization in two cases. Of the 12 aldosterone producing adenomas diagnosed, AVS crucially demonstrated lateralization in three patients where imaging showed bilateral or no adenomas, two of whom have had a surgical cure while the third is awaiting surgery. Furthermore, three patients had unilateral adrenal lesions on CT but bilateral aldosterone secretion on AVS.
*All authors contributed equally on this abstract.
Our study demonstrates that AVS is critical in the subtype diagnosis of PA and should be performed by a dedicated radiologist with a standardized protocol. ACTH increases apparent cannulation success, but may lead to loss of lateralization. Performing AVS both pre- and post-ACTH stimulation will offer more data to determine the appropriateness of this component of the AVS procedure. The first two authors contributed equally to this work.