Background: Primary aldosteronism (PA) is one of the most prevalent
forms of secondary hypertension, which may be cured by unilateral adrenalectomy.
Adrenal vein sampling (AVS) is considered the gold-standard
procedure for distinction between bilateral and unilateral aldosterone hypersecretion.
However, the procedure is viewed as a technical challenge.
The objectives of this study were to define the success rate of AVS, and its
clinical determinants, and to compare the accuracy of high-resolution adrenal
computed tomography (CT) with AVS.
Methods: In this single-centre retrospective study, patients with biologically
proven PA who were referred for AVS between 2009 and 2014
were included. Adrenal vein catheterisation was considered selective if the
selectivity index (adrenal vein / inferior vena cava cortisol) was ≥2.
Results: Data from 68 patients (48% women) were available. The success
rate of catheterisation in bilateral AVS was 60% (41/68). The significant
clinical determinants of success were male sex (r = 0.35, p = 0.004), a
higher body mass index (BMI) (r = 0.54, p = 0.001) and plasma creatinine
(r = 0.25, p = 0.048) in univariate analysis. In multivariate linear regression
analysis, only BMI was associated with success (coefficient  = 0.049,
p = 0.004). CT was discordant with AVS in 53% of patients, and would have
resulted in inappropriate adrenalectomy in 43% of the patients and inappropriate
exclusion from surgery in 10% of the cases.
Conclusion: Clinical characteristics such as BMI and sex may influence the
success rate of AVS. The inaccuracy of CT may result in inappropriate
treatment proposals if the indication for surgical intervention is based on
CT only.