Rapid cortisol assay increases the success of adrenal vein sampling

The diagnosis of primary aldosteronism (PA) comprises screening, confirmatory testing and subtype diagnosis. This evaluation is essential to assign patients to the appropriate therapy of either mineralocorticoid receptor antagonists for patients with bilateral adrenal hyperplasia (BAH), or adrenalectomy for patients with aldosterone-producing adenomas (APA). The distinction between APA and BAH is made by CT scanning and adrenal vein sampling (AVS); the latter is a demanding technique requiring an expert and motivated radiologist. In this issue, Rossi et al., report their experience with the use of an intraoperative rapid cortisol assay (RCA) for increasing the success of bilateral cannulation of adrenal veins. RCA not only has the advantage of allowing the radiologist to perform further attempts at cannulation until cortisol measurements demonstrate sampling success but also avoids repetition of AVS when a satisfactory selectivity index (ratio between cortisol in the adrenal vein and cortisol in a peripheral vein) is not achieved despite multiple attempts. Therefore, RCA should be considered as a useful strategy to improve the AVS success.