Adrenal Venous Sampling for the Diagnosis of Hyperaldosteronism

Vascular and Interventional Radiology

  1. Notify the /mmunology lab that we will be bringing blood samples for in about 1-2 hours.
  2. Start Cosyntropin infusion at 40ug, (0.04mg)/hr, 30 minutes before adrenal vein catheterization and continue throughout the procedure. If 0.25mg of cosyntropin is diluted in 100cc of NS or dextrose the concentration is 0.0025mg/cc, and the infusion rate is 16cc/hr.
  3. Blood is obtained simultaneously from both the adrenal veins and the IVC below the renal veins and assayed for aldosterone and cortisol concentration.  Make sure all tubes are properly labeled and marked: Right, Left, IVC. Deliver blood specimens to the Lab. Have them run stat cortisol levels to verify the adrenal veins have been sampled.
  4. Discontinue the cosyntropin drip. Hold the patient in the post procedural area. Do Not remove the vascular sheaths until the Immunology Lab verifies that the samples have been collected properly. Restart the ACTH and resample if necessary.
  5. Interpretation:

Mean adrenal/IVC cortisol ratio: Right-32.1/1      Left-21.9/1
Mean Right to Left Cortisol gradient: 1.6/1     (range 0.5-9.6)
Cortisol-corrected lateralization ratio:

Unilateral source > 4.0/1
Overlap zone 3-4/1
Bilateral zone < 3.0/1

Possible sites of sampling:

Left adrenal         Right adrenal                      IVC,                     supra-renal IVC,                infra-renal IVC
Left renal               Right renal


Reference: Phechromocytoma and Primary Aldosteronism: Diagnostic Approaches. Endocrinology and Metabolism Clinics of NA. 1997;26(4):801-927

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