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

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.