Poster Presentation ESA-SRB 2023 in conjunction with ENSA

Improving adrenal vein sampling with point-of-care cortisol assays (#242)

Christopher Chan 1 2 , Brian Tran 1 2 , Yu-Fang Wu 2 , Cankayan Suthaharen 3 , Luke Baker 4 , Joshua Ryan 3 , Christian Girgis 1 2
  1. Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
  2. Department of Diabetes and Endocrinology, Westmead Hospital, Sydney, NSW, Australia
  3. Institute of Clinical Pathology and Medical Research (ICPMR), Westmead Hospital, Sydney, NSW, Australia
  4. Department of Radiology, Westmead Hospital, Sydney, NSW, Australia

Background: There is an increasing prevalence of primary aldosteronism in recent decades1. Adrenal vein sampling (AVS) remains the gold standard in identifying unilateral surgically curable causes of primary aldosteronism2,3. AVS is a time-consuming, expensive, invasive and technically challenging procedure1,4,5 with success rates historically dependent on centre-specific expertise and ranging between 30% and 96%6. Rapid point-of-care cortisol assays (POCCA) have been shown to improve success rates even in less experienced hands2,7-9.

Aims: Review effectiveness of POCCA (Trust Medical, Japan) for successful bilateral cannulation

Methods: AVS was performed using ACTH stimulation protocol (50 micrograms/hr continuous cosyntropin). In procedures undertaken between January 2019 and March 2022 (n=33), successful intraprocedural cannulation was determined using standard radiological criteria and POCCA were not utilised (pre-POCCA group). From April 2022 to August 2023, the use of POCCA was implemented to confirm successful intraprocedural cannulation for all patients (n=25) (POCCA group).

Successful cannulation was confirmed post-procedurally using standard biochemical criteria with adrenal/paired peripheral cortisol levels (Selectivity index= SI) ≥ 3.0

Assessment of cannulation success using POCCA was evaluated on-site by 3 independent reviewers blinded to the lab results.

Result: The pre-POCCA group had 16 successful bilateral cannulations (48.5%), 12 unsuccessful on the right vein only, and 5 unsuccessful bilaterally on post-procedure biochemistry. Two patients accounted for 4/5 bilaterally unsuccessful cases.

For the POCCA group, 22/25 cases (88%) had intraprocedural and post-procedure biochemical confirmation of successful bilateral cannulation. The 3 unsuccessful cases were related to difficulties in aspirating the right adrenal vein only.

POCCA imparted a 2 fold improvement in successful bilateral cannulation between the groups (p = 0.002).

Conclusion: This demonstrates an improvement in success rates in AVS over a 3-year period with the use of POCCA. The use of POCCA allowed for earlier treatment decisions when considering sample collection and repeat attempts.

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