Objective  To investigate the effect of stress during sequential adrenal venous sampling (AVS) on lateralization assessment of aldosteronism secretion in patients with primary aldosteronism.

Methods  This cross-sectional study included 74 patients with primary aldosteronism who underwent AVS at Daping Hospital from September 2021 to March 2022. CT imaging revealed two lesion types: adenomas and non-adenomatous lesions. The patients were divided into two groups using the random number table method: a sequential blood sampling group of 40 cases including 13 adenomas and 27 non-adenomas, and a synchronous blood sampling group of 34 cases including 9 adenomas and 25 non-adenomas. AVS procedures without adrenaline stimulation were carried out by the only one operator. In the sequential blood sampling group, blood was sampled twice from the right adrenal vein. The first sampling was named as t-0. The second sampling named t-15 was performed 15 minutes later. The two sampling simulated the states of stress and non-stress, separately. To determine the impact of the stress response on the interpretation of AVS results, plasma aldosterone concentration (PAC), plasma cortisol concentration (PCC), standardized aldosterone corrected by PCC, and laterality index (LI) were analyzed in sequential group, synchronous group, and in patients with different lesion types.

Results  Bilateral adrenal venous catheterization was successfully completed in all patients. In the sequential blood sampling group, compared with t-0, the right PCC at t-15 was significantly decreased 762.00 (464.50, 1241.00) μg/L vs. 2 697.00 (864.00, 6 107.00) μg/L, Z=−4.516, P＜0.001, the standardized right PAC was significantly increased 0.27 (0.15, 0.70) vs. 0.14 (0.07, 0.35), Z=−3.880, P=0.001, and the right LI was significantly increased 1.53 (0.67, 4.01) vs. 0.99 (0.24, 2.31), Z=−3.909, P＜0.001. At t-0, the right PCC was significantly higher than the left 2 697.00 (864.00, 6 107.00) μg/L vs. 1 361.5 (671.50, 2 033.50) μg/L, Z=−2.295, P=0.022, while at t-15, the right PCC was significantly lower than the left 762.00 (464.50, 1 241.00) μg/L vs. 1 361.5 (671.50, 2 033.50) μg/L, Z=−2.026, P=0.043. The consistency rate of lateralization determination of aldosteronism secretion between t-0 and t-15 in the sequential blood sampling group was 85% (Kappa=0.662, P＜0.001). For patients with the non-adenoma lesion and adenoma lesion, right PCC levels were lower, standardized right PAC levels were higher at t-15 than t-0. For the patients with non-adenoma lesion, LI was higher at t-15 than t-0. However, for adenoma lesion, no difference in LI was observed between t-15 and t-0. In the synchronous blood sampling group, there was no statistically significant difference in the PCC levels between the right and left sides in the overall patients and patients with non-adenoma lesion and adenoma lesion.

Conclusion  Stress during sequential AVS can affect lateralization assessment in patients with primary aldosteronism, especially in patients with non-adenoma lesions.