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Cardiovascular Endocrinology

SUN-250 - Dual-Site Left Adrenal Venous Sampling in Non-ACTH-Stimulated AVS for Primary Aldosteronism Subtyping: A Single-Centre Retrospective Study

Sunday, June 14, 2026
9:00 AM - 4:00 PM CT
Location: ENDOExpo; Poster Floor

    Senior Author/Primary Investigator(s)

  • MH

    Minzhi He, MM (he/him/his)

    The Second Affiliated Hospital of Zhejiang University School of Medicine
    Hangzhou, China (People's Republic)

    • Co-Author(s)

  • MJ

    Minyue Jia, MM (she/her/hers)

    The Second Affiliated Hospital of Zhejiang University School of Medicine
    Hangzhou, China (People's Republic)

  • YJ

    Yongli Ji, MD

    The Second Affiliated Hospital of Zhejiang University School of Medicine
    Hangzhou, China (People's Republic)

  • YZ

    Yuhao Zhang, MD (he/him/his)

    The Second Affiliated Hospital of Zhejiang University School of Medicine
    Hangzhou, China (People's Republic)

  • JW

    Jiaming Wen, MD (he/him/his)

    The Second Affiliated Hospital of Zhejiang University School of Medicine
    Hangzhou, China (People's Republic)

  • ZD

    Zhichao Dong, MM (he/him/his)

    The Second Affiliated Hospital of Zhejiang University School of Medicine
    Hangzhou, China (People's Republic)

  • XP

    Xin Pan, MM (she/her/hers)

    The Second Affiliated Hospital of Zhejiang University School of Medicine
    Hangzhou, China (People's Republic)

    • Senior Author/Primary Investigator(s)

  • ZL

    Zhenjie Liu, MD (he/him/his)

    the Second Affiliated Hospital Zhejiang University School of Medicine
    Hangzhou, United States

    • Rapid and Poster Presenter(s)

  • xiaoxiao song, MD (she/her/hers)

    Associate Chief Physician
    The Second Affiliated Hospital, Zhejiang University School of Medicine
    Hangzhou, China (People's Republic)

    • Senior Author/Primary Investigator(s)

  • xiaoxiao song, MD (she/her/hers)

    Associate Chief Physician
    The Second Affiliated Hospital, Zhejiang University School of Medicine
    Hangzhou, China (People's Republic)

    • Co-Author(s)

  • xiaoxiao song, MD (she/her/hers)

    Associate Chief Physician
    The Second Affiliated Hospital, Zhejiang University School of Medicine
    Hangzhou, China (People's Republic)

Disclosure(s):
xiaoxiao song, MD: No financial relationships to disclose

Background
Adrenal venous sampling (AVS) is the gold standard for subtype classification of primary aldosteronism (PA); however, the optimal sampling site in the left adrenal vein remains controversial. Blood can be obtained from either the left central vein (LCV) or the common trunk (CMT), and discordant lateralisation between these sites has been reported. In addition, comparative analyses of dual left sampling sites under non–ACTH-stimulated conditions remain limited.

Objective
To determine whether dual-site sampling from both the LCV and CMT reduces false-negative lateralisation in non–ACTH-stimulated AVS.

Methods
We retrospectively analysed 424 consecutive patients with confirmed PA who underwent non–ACTH-stimulated AVS between 2019 and 2025. After confirming successful cannulation at all adrenal sampling sites (selectivity index [SI] ≥ 2.0 on both sides and at both left-sided sampling positions), 362 patients were included. Plasma aldosterone concentration (PAC) and plasma cortisol concentration (PCC) were measured in paired LCV and CMT samples. Lateralisation indices (LI) were calculated, and agreement between sampling sites was assessed using Pearson correlation and Bland–Altman analyses.

Results
The CMT failed to meet the selectivity threshold more frequently than the LCV (9.9% vs. 2.8%, P < 0.05). Among the 362 fully selective paired samples, PAC, PCC, and SI were consistently higher in the LCV than in the CMT (aldosterone: 2460 [646–12,100] vs. 2255 [599–9148] pg/mL; cortisol: 1527 [774–3814] vs. 1160 [666–3028] nmol/L; SI: 7.97 [4.24–19.35] vs. 6.19 [3.43–14.07]; all P < 0.01), whereas cortisol-corrected PAC/PCC ratios were similar between sites. Lateralisation was fully concordant in 291 patients (80.4%), grossly discordant—defined as opposite dominant sides—in 7 patients (1.9%), and partially discordant—defined as lateralisation at one site but not the other—in 64 patients (17.7%). All grossly discordant cases occurred in patients with left-sided or bilateral disease. Overall PAC/PCC correlation between the two sites was strong but lower in the left-dominant group (r = 0.69) than in the right-dominant (r = 0.86) or bilateral aldosterone secretion groups (r = 0.83). Bland–Altman analyses similarly demonstrated better agreement in right-dominant and bilateral groups than in the left-dominant group.

Conclusion
In this large single-centre retrospective study of non–ACTH-stimulated AVS, LCV and CMT sampling showed high overall concordance when selectivity was achieved. However, clinically relevant discordance occurred predominantly in patients with left-sided or bilateral disease, likely reflecting dilution effects at the CMT and potential over-selectivity at the LCV. Dual-site sampling may therefore improve diagnostic confidence and reduce false-negative lateralisation, particularly in patients with suspected left adrenal lesions.