Rapid cortisol measurement aids in real-time confirmation of successful cannulation during adrenal venous sampling (AVS)

Stowasser, M., Ward, G., Leggett, D., Cowley, D. and Gordon, R. (2008). Rapid cortisol measurement aids in real-time confirmation of successful cannulation during adrenal venous sampling (AVS). In: J. E. Hall, Hypertension. Proceedings of the High Blood Pressure Research Council of Australia 2006 Annual Scientific Meeting. 28th Annual Scientific Meeting of the High Blood Pressure Research Council of Australia, Brisbane, Australia, (1477-1477). 7-8 December 2006. doi:10.1161/HYPERTENSIONAHA.107.009421


Author Stowasser, M.
Ward, G.
Leggett, D.
Cowley, D.
Gordon, R.
Title of paper Rapid cortisol measurement aids in real-time confirmation of successful cannulation during adrenal venous sampling (AVS)
Conference name 28th Annual Scientific Meeting of the High Blood Pressure Research Council of Australia
Conference location Brisbane, Australia
Conference dates 7-8 December 2006
Proceedings title Hypertension. Proceedings of the High Blood Pressure Research Council of Australia 2006 Annual Scientific Meeting   Check publisher's open access policy
Journal name Hypertension   Check publisher's open access policy
Place of Publication Philadelphia
Publisher American Heart Association
Publication Year 2008
DOI 10.1161/HYPERTENSIONAHA.107.009421
ISSN 0194-911X
1524-4563
Editor J. E. Hall
Volume 49
Issue 6
Start page 1477
End page 1477
Total pages 1
Collection year 2008
Language eng
Abstract/Summary AVS plays a critical role in the diagnostic workup of primary aldosteronism (PAL) as it is the most reliable means of differentiating unilateral forms (e.g. aldosterone-producing adenoma) correctable by unilateral adrenalectomy, from bilateral forms usually treated with aldosterone antagonist medications. Examination of the adrenal/peripheral venous (AV/PV) cortisol ratio permits assessment of the adequacy of AVS. Ratios of 3 indicate adequate sampling. The right adrenal vein (RAV) is often harder to locate than the left (LAV) as it usually is smaller and empties into the inferior vena cava (IVC) rather than the renal vein at a level ranging from upper T11 to mid L1. Thus, even in highly experienced hands, the RAV cannulation success rate (87% at Princess Alexandra Hospital) is lower than that for LAV (94%). Use of contrast CT prior to AVS has contributed to high success rates achieved in our institutions by permitting visualization of the RAV at its point of entry into the IVC. We recently instituted an on-the-spot method of measuring plasma cortisol that permits determination of AV levels within 12 min of collection. Rapid cortisol estimation was performed by competitive fluorescence polarization assay using a TDx analyser and the TDx reagent system for cortisol. The standard assay for cortisol was modified by reducing the original 16 min incubation time to 6 min by following a test protocol on the analyser originally used for measuring ethosuximide. The requirement for only 50 L sample volumes allowed rapid centrifugation (4 min). Measurement of RAV and simultaneously collected PV cortisol levels was undertaken while the radiologist collected samples from the LAV, resulting in minimal or no prolongation of the AVS procedure. Cortisol levels of 1500 nmol/L could be estimated accurately, permitting reliable assessment of cannulation success provided PV levels were 500 nmol/L (which was almost always the case). This method proved accurate when compared with an established competitive chemiluminescent immunoassay (ADVIA Centaur). This approach offers a means of definitively establishing, at the time of AVS, whether AV cannulation has been successful, and thereby promises to reduce the number of samples required and the need for repeat procedures.
Subjects 321004 Endocrinology
730105 Endocrine organs and diseases (incl. diabetes)
EX
Keyword Peripheral Vascular Disease
Q-Index Code EX
Q-Index Status Provisional Code
Additional Notes Abstract number: 75

 
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Created: Mon, 18 Feb 2008, 17:18:20 EST