Influence of Diagnostic Criteria on the Interpretation of Adrenal Vein Sampling

International audience; Guidelines promote the use of adrenal vein sampling to document lateralized aldosterone hypersecretion in primary aldosteronism. However, there are large discrepancies between institutions in the criteria used to interpret its results. This study evaluates the consequences of these differences on the classification and management of patients. The results of all 537 adrenal venous sampling performed between 01/2001 and 07/2010 in our institution were interpreted with four diagnostic criteria used in experienced institutions where adrenal vein sampling is performed without cosyntropin (Brisbane, Padua, Paris, and Turin), and with criteria proposed by a recent consensus statement. Adrenal vein sampling were classified as unsuccessful, lateralized, or not lateralized according to each set of criteria. Almost five times more adrenal vein sampling were classified as unsuccessful with the strictest criteria than with the least strict criteria (18% versus 4%, respectively). Similarly, over two times more adrenal vein sampling were classified as lateralized with the least stringent criteria than with the most stringent criteria (60% versus 26%, respectively). Multiple samples were available from at least one side for 155 adrenal vein sampling. These procedures were classified differently by at least two right-left sample pairs in 12% to 20% of cases. Thus, different sets of criteria used to interpret adrenal vein sampling in experienced institutions translate into heterogeneous classifications, and hence management decisions, for patients with primary aldosteronism.Defining the most appropriate procedures and diagnostic criteria is needed for adrenal vein sampling to achieve optimal performance and fully justify its status as a gold standard.