Cardiovascular Endocrinology

ORF31-04 - Adrenal Vein Sampling for Identifying Surgically Treatable Primary Aldosteronism: Towards an International Expert Consensus

Sunday, June 14, 2026

2:00 PM - 2:15 PM CT

Location: Room W187

Oral Abstract Presenter(s)

AT

Adina F. Turcu, MD

University of Michigan,
Ann Arbor, Michigan, United States

Senior Author/Primary Investigator(s)

AT

Adina F. Turcu, MD

University of Michigan,
Ann Arbor, Michigan, United States

Co-Author(s)

Madson Almeida, MD, PhD

Professor
University of Sao Paulo
Sao Paulo, BRAZIL
Marta Araujo-Castro, Sr., MD, PhD (she/her/hers)

Doctor
HOSPITAL RAMON Y CAJAL
Tres Cantos, Spain
Richard J. Auchus, MD,PhD

Professor
University of Michigan
Ann Arbor, MI, United States
Felix Beuschlein, MD

Professor
University Hospital Zurich
Zurich, Switzerland
MB

Morris J. Brown, FMedSci, FRS

Queen Mary University of London
London, United Kingdom
JD

Jaap 1. Deinum, MD

Radboud University Medical Center
Nijmegen, Netherlands
CG

Celso Gomez-Sanchez, MD

University of Mississippi Medical Center
Jackson, Missouri, United States
SH

Stefanie Hahner, MD

University Hospital of Wuerzburg
Wuerzburg, Germany
JH

Jinbo Hu, MD

First Affiliated Hospital of Chongqing Med
Chongqing, China (People's Republic)
JK

Jung Hee Kim, MD PhD

M.D.
Seoul National University Hospital
Seoul, Republic of Korea
GK

Gregory Kline, MD

University of Calgary
Calgary, Canada
Andr� Lacroix, MD (he/him/his)

Professor of Medicine
CHUM Universite de Montreal
Montreal, QC, Canada
Paolo Mulatero, MD

Full Professor
University of Torino
Torino, Italy
MN

Mitsuhide Naruse, MD

Takeda General Hospital
Kyoto, Japan
TN

Tetsuo Nishikawa, MD

Yokohama Rosai Hospital
Yokohama, Japan
Troy Puar, MBBS, FRCP (UK), PhD (he/him/his)

Senior Consultant
Department of Endocrinology, Changi General Hospital, Singhealth, Singapore
Singapore, Singapore
MQ

Marcus Quinkler, MD

Endocrinology in Charlottenburg
Berlin, Germany
OR

Oskar Ragnarsson, MD

Sahlgrenska University Hospital
Gothenburg, Sweden
MR

Martin Reincke, MD, PhD (he/him/his)

Department of Medicine IV, LMU Hospital, Ludwig-Maximilians-Universität München
Munich, Germany
FS

Fumitoshi Satoh, MD

Tohoku University Graduate School of Medicine
Sendai, Japan
HS

Hirotaka Shibata, MD, PhD (he/him/his)

Oita University Faculty of Medicine
Yufu city, Oita, Japan
MS

Michael Stowasser, MBBS, FRACP, PhD (he/him/his)

University of Queensland Frazer Institute
Brisbane, Australia
AV

Anand Vaidya, MD, MMSc (he/him/his)

Chief, Division of Endocrinology, Diabetes, and Metabolism; Director, Center for Adrenal Disorders; Associate Professor of Medicine
Mass General Brigham, Harvard Medical School
Boston, MA, United States
Vw

Vin-Cent wu, MD

National Taiwan University Hospital
Taiwan, Taiwan (Republic of China)
JY

Jun Yang, MBBS, FRACP, PhD (she/her/hers)

Head of Endocrine Hypertension Group
Hudson Institute of Medical Research
Clayton, Victoria, Australia
William F. Young, Jr., MD, MSc

Clinician
Mayo Clinic
Rochester, MN, United States
TW

Tracy Williams, PhD

LUDWIG-MAXIMILIANS-UNIVERSITT MNCHEN
Munich, Germany

Disclosure(s):

Jung Hee Kim: No financial relationships to disclose

Anand Vaidya, MD, MMSc: No relevant disclosure to display

Background: Adrenal vein sampling (AVS) has been the primary tool for identifying surgical candidates among patients with primary aldosteronism (PA). Nevertheless, standardized protocols for conducting the procedure and for interpreting the hormonal data have been lacking.

Methods: We assembled an international panel of 23 experts from 16 countries, aiming to develop consensus criteria for AVS procedure and interpretation, and to identify areas of uncertainty requiring future research. Using the Delphi method, the process included 3 rounds of questionnaires, monitored by a core committee. A minimum 70% agreement was required to reach consensus for each question.

Results: Of the 23 participating centers of expertise, 61% performed sequential cannulation, and 39% simultaneous cannulation; 17.4% performed AVS only without cosyntropin stimulation, 34.8% only after cosyntropin stimulation, and 47.8% both before and after cosyntropin stimulation. Cosyntropin administration varied from bolus, continuous infusion or both, and samples were obtained between 5 to over 60 min from cosyntropin initiation.
Consensus was reached for criteria in 5 domains:
1. Patient selection for AVS;
2. Procedure pre-requisites (importance of eukalemia, renin suppression, avoidance of general anesthesia);
3. Procedure execution (simultaneous bilateral AVS is preferred; when done sequentially, bias can be minimized by using cosyntropin stimulation, and cannulating the right adrenal vein first);
4. Hormonal data interpretation related to selectivity index and contralateral suppression.
5. Special circumstances (cortisol co-secretion, iodine contrast allergy).
Areas identified that require further research included: cosyntropin use and method of administration during AVS, optimal criteria for lateralization, and interpretation of partial hormonal data. Regarding lateralization, the experts agreed that:
1. The likelihood of surgical cure increases with higher lateralization index.
2. Strong lateralization cannot exclude asymmetrical bilateral PA.
3. Due to variable expression of MC2R in aldosterone-producing adenomas and surrounding cortex, lateralization might occur only at baseline or only after cosyntropin stimulation.
4. The management of patients with inconsistent lateralization should be individualized, following a multidisciplinary discussion.

Conclusions: Although AVS has been the standard of care for PA subtyping for decades, wide variability remains regarding optimal AVS protocols and interpretation in expert centers. We have initiated an international retrospective data collection from >30 centers, anticipated to compile >3000 AVS cases, aimed to compare outcomes across various protocols.