How is adrenal venous sampling performed in the workup of primary aldosteronism?

Updated: Mar 24, 2020
  • Author: Gabriel I Uwaifo, MD; Chief Editor: Romesh Khardori, MD, PhD, FACP  more...
  • Print
Answer

Technique

The adrenal veins are catheterized via a percutaneous femoral venous approach. Right and left venous catheters should be placed in the ipsilateral adrenal veins to prevent errors in handling the samples. (Cannulation of the right adrenal vein is technically difficult because of the short length of this vessel. The left adrenal vein is longer, allowing for more stable catheter placement.)

At baseline and following corticotropin stimulation (preferably by continuous infusion at 50 mcg/h for the duration of the sampling study), blood samples are obtained simultaneously from both adrenal veins, as well as from the inferior vena cava, and the samples are assayed for aldosterone and cortisol.

In order to document the placement of the catheters within the adrenal veins, an adrenal-to–vena cava cortisol ratio (post corticotropin) is calculated; it should be greater than 5-10.


Did this answer your question?
Additional feedback? (Optional)
Thank you for your feedback!