Subtyping of primary aldosteronism in the AVIS-2 study: Assessment of selectivity and lateralization

Giacomo Rossitto, Laurence Amar, Michel Azizi, Anna Riester, Martin Reincke, Christoph Degenhart, Jiri Widimsky, Mitsuhide Naruse, Jaap Deinum, Leo Schultzekool, Tomaz Kocjan, Aurelio Negro, Ermanno Rossi, Gregory Kline, Akiyo Tanabe, Fumitoshi Satoh, Lars Christian Rump, Oliver Vonend, Holger S. Willenberg, Peter FullerJun Yang, Nicholas Yong Nian Chee, Steven B. Magill, Zulfiya Shafigullina, Marcus Quinkler, Anna Oliveras, Chin Chen Chang, Vin Cent Wu, Zusana Somloova, Giuseppe Maiolino, Giulio Barbiero, Michele Battistel, Livia Lenzini, Emilio Quaia, Achille Cesare Pessina, Gian Paolo Rossi

Research output: Contribution to journalArticlepeer-review

40 Citations (Scopus)


Context: Adrenal venous sampling (AVS) is the key test for subtyping primary aldosteronism(PA), but its interpretation varies widely across referral centers and this can adversely affect themanagement of PA patients.Objectives: To investigate in a real-life study the rate of bilateral success and identification ofunilateral aldosteronism and their impact on blood pressure outcomes in PA subtyped by AVS.Design and settings: In a retrospective analysis of the largest international registry of individual AVS data (AVIS-2 study), we investigated how different cut-off values of the selectivity index(SI) and lateralization index (LI) affected rate of bilateral success, identification of unilateralaldosteronism, and blood pressure outcomes.Results: AVIS-2 recruited 1625 individual AVS studies performed between 2000 and 2015 in 19tertiary referral centers. Under unstimulated conditions, the rate of biochemically confirmedbilateral AVS success progressively decreased with increasing SI cut-offs; furthermore, withcurrently used LI cut-offs, the rate of identified unilateral PA leading to adrenalectomy wasas low as <25%. A within-patient pairwise comparison of 402 AVS performed both underunstimulated and cosyntropin-stimulated conditions showed that cosyntropin increased theconfirmed rate of bilateral selectivity for SI cut-offs = 2.0, but reduced lateralization rates(P < 0.001). Post-adrenalectomy outcomes were not improved by use of cosyntropin or morerestrictive diagnostic criteria.Conclusion: Commonly used SI and LI cut-offs are associated with disappointingly low ratesof biochemically defined AVS success and identified unilateral PA. Evidence-based protocolsentailing less restrictive interpretative cut-offs might optimize the clinical use of this costly andinvasive test.

Original languageEnglish
Pages (from-to)2042-2052
Number of pages11
JournalJournal of Clinical Endocrinology and Metabolism
Issue number6
Publication statusPublished - 2020 Jun 1


  • Adrenal vein sampling
  • Aldosterone
  • Aldosteronism
  • Diagnosis
  • Registry

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism
  • Biochemistry
  • Endocrinology
  • Clinical Biochemistry
  • Biochemistry, medical


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