What is the role of adrenal venous sampling (AVS) in the workup of primary hyperaldosteronism?

Updated: Sep 08, 2020
  • Author: George P Chrousos, MD, FAAP, MACP, MACE, FRCP(London); Chief Editor: Robert P Hoffman, MD  more...
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AVS is the criterion standard test to differentiate unilateral (APA or UAH) from bilateral disease in patients with PA; however, it requires considerable skill. It can be performed as an outpatient procedure, although younger children may need general anesthesia. Ideally, the procedure should be performed in centers with appropriate expertise. Adrenal veins are often small, and the right vein tends to be difficult to cannulate.

According to a consensus statement from an international panel of experts, AVS is not necessarily required in patients older than 40 years with marked PA and a clear unilateral adrenal adenoma and a normal contralateral adrenal gland on computed tomography imaging, in patients with unacceptable high risk of adrenal surgery (eg, multiple comorbidities in elderly patients), in patients suspected of having an adrenocortical carcinoma, or in patients with proven FH-I or with FH-III. [44]

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