Adrenal vein sampling in primary aldosteronism: a retrospective analysis of clinical experience in the Middle East.

CONTEXT: Adrenal vein sampling (AVS) is the gold standard for lateralizing aldosterone secretion in primary aldosteronism (PA) management. However, due to challenges in expertise and infrastructure, it remains underutilized in the Middle East (ME).

OBJECTIVES

This study aimed to document the performance and outcomes of AVS in the ME.

METHODS

This retrospective study included patients with PA who underwent AVS at a tertiary care hospital in Qatar (2015 - 2024). Clinical, biochemical, imaging and procedural data were collected to evaluate AVS success rates, imaging-AVS concordance and treatment outcomes. AVS success was defined as correct bilateral adrenal vein cannulation, determined by selectivity indices (unstimulated SI ≥ 2 or cosyntropin-stimulated SI ≥ 5).

RESULTS

The cohort (n = 31) had a mean age of 50.29 ± 8.19 years, with a male predominance (67.7%). AVS was successful in 71% (n = 22). There was a 59% concordance between AVS and adrenal imaging. Of those with successful AVS (n = 22), adrenalectomy was performed in 54.5% of patients, with 66.7% requiring fewer antihypertensives than pre-AVS. Pre-AVS hypokalemia resolved in 75% of patients undergoing AVS-guided adrenalectomies vs. 20% in the medically managed group.

CONCLUSION

This study is the first to demonstrate AVS's safety and efficacy in the ME, achieving a 71% success rate. With an AVS-imaging concordance of only 59%, the study highlights the clinical significance of AVS in guiding optimal management decisions. AVS-directed interventions lead to better treatment strategies with high post-treatment cure rates. The role of technology, such as intraprocedural dynaCT, is reinforced in improving procedural accuracy.