Adrenal Vein Sampling

Adrenal vein sampling: Overview

Adrenal vein sampling (AVS) is an interventional radiology study performed by radiologists trained specifically in performing invasive procedures using catheters. Adrenal vein sampling is used in patients with primary hyperaldosteronism (Conn’s syndrome) when the adrenal CT scan does not show a tumor (the tumor is too small to be detected on a CT or MRI scan) or in patients who have adrenal tumors on both the right and the left side.

In adrenal vein sampling, operator experience matters

There is a very strong correlation between the expertise and experience of the interventional radiologist and the results of adrenal vein sampling. The most expert centers for adrenal vein sampling has a technical success rate exceeding 90%. The technical success is directly related to the operator experience. Your job and the job of your doctors are to find the most experienced interventional radiologist to perform your procedure. An expert interventional radiologist has a much higher success rate, lower complication rates and can perform the procedure much faster than somebody who is not an expert. There are very few experts performing adrenal vein sampling in the United States, less than a dozen. If you have primary hyperaldosteronism, it is definitely worth traveling to an expert center for your adrenal vein sampling.

The Carling Adrenal Center is the only place in the world where the patient can come in for adrenal vein sampling, and go on to have a curative adrenalectomy that same day.

MANY patients with primary hyperaldosteronism (Conn’s syndrome) do not need adrenal vein sampling

Patients who are young, have an obvious tumor on the CT scan, and with a completely normal adrenal gland on the other side do not need adrenal vein sampling. They can go straight to curative adrenalectomy and skip this step. Similarly, patients who respond very well to spironolactone and similar drugs and have very high aldosterone levels almost never need adrenal vein sampling. They can go straight to adrenal surgery.

After you have had your CT scan of your adrenal glands, you can contact us at the Carling Adrenal Center and will be happy to evaluate your case and determine whether or not you need adrenal vein sampling. If you need to have the procedure, we can perform both the adrenal vein sampling and the surgery during the same visit.

Adrenal vein sampling is not without risks

Adrenal vein sampling is not without risks. This is an invasive procedure. Again, the risk of complication is directly related to the experience and mastery of the interventional radiologist. The most common risks with the procedure are bleeding causing a hematoma, adrenal infarction, adrenal vein thrombosis and perforation (or rupture) of the adrenal vein. At the Carling Adrenal Center, we use very small amounts of contrast dye injection and have an extremely favorable safety profile. In fact, we have never had bleeding or injury to the adrenal veins during this procedure.

Even if adrenal vein sampling demonstrates that there is no obvious tumor on one of the adrenal glands, surgery could still be the best option

In the ideal scenario the adrenal vein sampling demonstrates significantly higher aldosterone production from one of the two adrenal glands (Figure 2 describes an ideal case). This makes surgery and adrenalectomy curative in nature. If there is overproduction of aldosterone from both adrenal glands, surgery still may be a very favorable option as opposed to just treating the patient with blood pressure pills for life. Surgery not only improves the blood pressure and potassium levels, but liberates the patients of debilitating symptoms, and improves the quality of life. Surgery can be particularly helpful in patients who are on several blood pressure medications, respond poorly to blood pressure medication or have developed resistance to blood pressure medications. Sometimes performing bilateral partial adrenalectomy may be the best option in patients with Conn’s syndrome due to aldosterone overproduction coming from both adrenal glands, when medical treatment is failing.

Adrenal vein sampling is NOT for patients with Cushing’s syndrome or pheochromocytoma

Adrenal vein sampling is only used in patients who have primary hyperaldosteronism (Conn’s syndrome) There is no role for adrenal vein sampling in patients who have cortisol-producing tumors causing Cushing’s syndrome or adrenaline-producing tumors causing pheochromocytoma. If your doctor wants to send you for adrenal vein sampling and you have any of these conditions, contact us at the Carling Adrenal Center.