Oral Presentations - Pathology and Laboratory Medicine - University ...

ResidentMajid Zolein 1 , Daniel T. Holmes 1,21Department of Pathology and Laboratory Medicine, University of British Columbia, 2 St.Paul’s Hospital Department of Pathology and Laboratory MedicineAbstract # 11a performance audit of adrenal vein sampling inbritish columbia: how are we doing?Majid ZoleinBackround/ObjectivesPrimary Aldosteronism (PA) is a treatable and often curable form of secondary hypertension affecting up to 10% ofindividuals who have a diagnosis of high blood pressure. Causes include, aldosterone producing adenoma (Conn’sSyndrome), bilateral adrenal hyperplasia, glucocorticoid remediable hypertension, and other rare forms.Because aldosteronomas are generally small, CT scan is unreliable to locate tumors. Therefore, once PA has beenclinically proven by provocative studies, Adrenal Vein Sampling (AVS) is used to determine if there is lateralizationof aldosterone production to one adrenal or the other. Success in AVS is technically hampered by the anatomy of theright adrenal vein which inserts directly into the IVC.Our objective was to audit the utility and success of AVS procedures in BC and to evaluate commonly employedbiochemical criteria for catheterization success. .MethodsThis was a retrospective audit of 90 cases of AVS which occurred from 2003-2010. Result of adrenal venous andperipheral venous cortisol and aldosterone were extracted from Vancouver Coastal laboratory information systems.All cases were systematically reviewed and calculations performed by standard approaches. Statistical analysis wasperformed using R (www.r-project.org).ResultsNumerous patients who did not have proven PA underwent the AVS procedure. Some patients had peripheral venousaldosterone results that actually excluded a diagnosis of PA. There was a statistically significant difference in the successrate of radiological operators with some having cannulation success rates of the right adrenal vein as low as 30%.Standard published biochemical catheterization criteria occasionally failed. ACTH stimulation during the procedureassisted in proving catheterization but obscured results on occasion. AVS helped localize adenomas that eluded CTand also helped identify some tumors as incidentaloma. CT prior to AVS assists in identifying anatomical variants.ConclusionAVS should be performed by a minimum number of operators. AVS utility in BC is inconsistent due to frequentlyfailed cannulation of the right adrenal vein. All patients who undergo the procedure should have PA proven by aprovocative test, with the exception of extreme presentations. ACTH stimulation during AVS is generally helpfulprovided its limitations are understood.Oral Presentations * 2 0 1 021